Academic journal article Nursing Praxis in New Zealand

Inpatient Hypoglycaemia: A Study of Nursing Management

Academic journal article Nursing Praxis in New Zealand

Inpatient Hypoglycaemia: A Study of Nursing Management

Article excerpt

In New Zealand, diabetes has been described as reaching epidemic status (Berkley & Lunt, 2006). The prevalence of Type 2 diabetes was predicted to increase from 123,944 people (3.2% of population) in 2001 to 194,380 (4.5% of population) in 2011 (Ministry Of Health, 2007). By 2012, 200,000 (5%) of New Zealand adults had been diagnosed with diabetes (Ministry of Health, 2012a). Diabetes is a significant cause of mortality in New Zealanders, and resulted in 869 deaths per 100,000 people during 2009 (Ministry of Health, 2012b).

Diabetes is the most commonly identified comorbidity in people admitted to hospital (Barnabas, Javed, Javed, & Kaushal, 2010). In Northland during 2005, 5% of all inpatients had diabetes and they used 21% of all the bed days (Northland District Health Board, 2006). Patients with diabetes have complex health care needs in the hospital setting and may experience prolonged lengths of stay and increased rates of inpatient infection, disability and mortality (Moghissi et al., 2009). Whilst tight glycaemic control has been advocated for the Intensive Care Unit (ICU) patient for some time, good metabolic control is now also recommended for all patients with diabetes in the non-ICU context as a means to improve clinical outcomes (American Diabetes Association, 2006; Turchin et al., 2009).

Hypoglycaemia is known to be common amongst inpatients. The 2007 study by Cagiliero, Grant, Meigs, Nathan and Wexler of 999 patients admitted to 44 hospitals across the United States of America found hypoglycaemia occurred in 12-18% of cases. One of largest studies (n=2,582) of inpatient hypoglycaemia undertaken to date also in the United States, identified that mortality during admission in patients who had at least one episode was 2.96% compared with 0.82% for patients who did not develop hypoglycaemia. Inpatient mortality increased dramatically with each additional day that hypoglycaemia was present (Greenwood, et al., 2009).

The consensus in the literature is that inpatient hypoglycaemia is largely preventable. There is frequently a component within the delivery of care which, if modified in a timely manner, could prevent or reduce the risk of hypoglycaemia (Anthony, 2007; Huynh, Maynard, & Renvall, 2008; Smith, Winterstein, Johns, Rosenberg, & Sauer, 2005; Wagner, 2000).

The evidence that poor patient outcomes are associated with inpatient hypoglycaemia and that clinical staff fail to respond to or treat episodes effectively has prompted many institutions to develop guidelines for diabetes management and protocols specific to the treatment of hypoglycaemia (American College of Endocrinolgy & American Diabetes Association, 2006). Despite this, nursing care has continued to be suboptimal, particularly in regard to adherence to hospital protocols for the management of hypoglycaemia (Anthony, 2007). The observation that many patients in our Northland hospital were experiencing hypoglycaemia and that the hospital protocol for its management was not consistently followed was the catalyst for this study.

Study Design and Method

A retrospective audit of the treatment and progress notes of patients admitted to Whangarei Hospital between November 2009 and January 2010 was used to depict nursing adherence to the Northland District Health Board's (NDHB) protocol "Management of Hypoglycaemia in Patients with Diabetes". This secondary level facility is the region's main hospital, providing 223 inpatient beds and specialist care to the Northland population (Northland District Health Board, 2010). Ethical approval for this study was granted by the Northern X Regional Ethics Committee.

Whangarei Hospital has two general adult medical and two general adult surgical wards. All four wards were included to ensure that the sample was representative of the general adult inpatient population. Only patients with either Type One or Type Two Diabetes who had experienced an episode of inpatient hypoglycaemia, and who were prescribed an oral hypoglycaemic agent and/or insulin were included in the study. …

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