EP.TU.200Improving variable rate insulin infusion compliance in general surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jayan George ◽  
Samuel Jackson ◽  
Andrew Orsi ◽  
Rohan Ardley
Keyword(s):  
Insulin Infusion ◽  
Further Education ◽  
Junior Doctors ◽  
Variable Rate ◽  
Oral Medications ◽  
Acting Insulin ◽  
Open Questions ◽  
Audit Data ◽  
Improve Compliance ◽  
Long Acting

Abstract Aims 1. Audit the current variable rate insulin infusion (VRII) practice per local guidelines. 2. Understand barriers to good VRII practice to create an intervention. 3. Re-Audit the VRII practice following intervention. Methods Junior doctors were surveyed using Likert scales (1 to 5: not at all confident to very confident) as well as closed and open questions. Chain action reaction (CAR) theory was used. Six domains were identified against a local proforma. Initial audit and questionnaire were collected from November 2019 to January 2020 and analysed using Microsoft Excel. Intervention consisted of a condensed one-page algorithm with group teaching. Re-audit data was collected between June 2020 to August 2020 for comparison. Results Questionnaire – 53.6% (15/28) of juniors responded. Challenges included conversion oral hypoglycaemics and complexity of the guidance. Group teaching and a condensed portable format were the most popular modalities for delivery of further education. Initial Audit – 12 VRII charts were audited. 33.3% (4/12) were completed correctly. Areas of significant need for improvement were as follows: ensuring long-acting insulin is prescribed, transferring from a VRII back to oral medications and appropriate fluid prescribing. Re-Audit – 18 charts were audited following intervention. Of these, 66.7% (12/18) were completed correctly. There was a significant improvement in appropriate fluid prescribing and long-acting insulin prescriptions. Conclusions Understanding the factors involved throughout the chain of how VRIIs are prescribed has helped to implement a positive intervention in our department. The improvement has been significant (100% better) however there is still further work required to improve compliance.

scholarly journals Diabetic Ketoacidosis Updates: Titratable Insulin Infusions and Long-Acting Insulin Early

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Justin Kinney ◽  
Oshin Baroi ◽  
Mania Gharibian
Keyword(s):  
Diabetic Ketoacidosis ◽  
Insulin Infusion ◽  
Hospital Length ◽  
Adult Patients ◽  
Early Administration ◽  
Hospital Survival ◽  
Acting Insulin ◽  
Long Acting ◽  
Infusion Duration ◽  
Order Set

Background. To compare a titratable insulin infusion order set (vs. nontitratable) and early administration of long-acting insulin in adult patients with diabetic ketoacidosis (DKA). Methods. Single health system, retrospective study of adult patients admitted to the intensive care unit (ICU) for DKA. The primary outcomes were insulin infusion duration and ICU/hospital length of stays (LoS). Secondary outcomes included ICU/hospital survival, hypoglycemia, and hypokalemia. Results. 151 patients were included in the titratable versus nontitratable insulin infusion comparison. Patients treated with the titratable insulin had shorter hospitalization (6.4 vs. 10.4 days, p = 0.03 ) and reduced the number hypoglycemic events by over half (20.6% vs. 46.0%, p < 0.01 ). 110 patients were identified to compare overlapping a long-acting insulin for more than 4 h with the insulin infusion versus the standard 1-2 h overlap. Patients who received the insulin early spent over 18 h longer on the infusion ( p < 0.01 ). Conclusions. A titratable insulin infusion added to the institutional DKA order set was associated with fewer days in the hospital and a significant reduction in hypoglycemic events. Furthermore, overlapping the long-acting insulin earlier with the insulin infusion early showed no benefit and could potentially be worse than the standard overlap.

Novel Long-Acting Insulin Effective

2011 ◽  
Vol 6 (4) ◽  
pp. 17
Author(s):  
MIRIAM E. TUCKER
Keyword(s):  
Acting Insulin ◽  
Long Acting

scholarly journals 145 Point of care lung ultrasound in patient triage: integration of ultrasound into a streaming pathway for COVID-19

2020 ◽  
Vol 37 (12) ◽  
pp. 839.1-839
Author(s):  
Dominic Craver ◽  
Aminah Ahmad ◽  
Anna Colclough
Keyword(s):  
Point Of Care ◽  
District General Hospital ◽  
Training Programme ◽  
Service Evaluation ◽  
University Hospital ◽  
Junior Doctors ◽  
Point Of Care Ultrasound ◽  
Face To Face ◽  
Point Of Care Diagnostics ◽  
Audit Data

Aims/Objectives/BackgroundRapid risk stratification of patients is vital for Emergency Department (ED) streaming during the COVID-19 pandemic. Ideally, patients should be split into red (suspected/confirmed COVID-19) and green (non COVID-19) zones in order to minimise the risk of patient-to-patient and patient-to-staff transmission. A robust yet rapid streaming system combining clinician impression with point-of-care diagnostics is therefore necessary.Point of care ultrasound (POCUS) findings in COVID-19 have been shown to correlate well with computed tomography (CT) findings, and it therefore has value as a front-door diagnostic tool. At University Hospital Lewisham (a district general hospital in south London), we recognised the value of early POCUS and its potential for use in patient streaming.Methods/DesignWe developed a training programme, ‘POCUS for COVID’ and subsequently integrated POCUS into streaming of our ED patients. The training involved Zoom lectures, a face to face practical, a 10 scan sign off process followed by a final triggered assessment. Patient outcomes were reviewed in conjunction with their scan reports.Results/ConclusionsCurrently, we have 21 ED junior doctors performing ultrasound scans independently, and all patients presenting to our department are scanned either in triage or in the ambulance. A combination of clinical judgement and scan findings are used to stream the patient to an appropriate area.Service evaluation with analysis of audit data has found our streaming to be 94% sensitive and 79% specific as an indicator of COVID 19. Further analysis is ongoing.Here we present both the structure of our training programme and our integrated streaming pathway along with preliminary analysis results.

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