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Imperial College Healthcare NHS Trust

The team titled their campaign ‘Don’t Risk it For a Biscuit’ and used data from the 2015 National Inpatient Diabetes Audit (NaDIA) for the Hammersmith renal unit as the basis of their education.

The findings showed:

  • Hypoglycaemia was common, particularly amongst dialysis patients
  • The majority of these occurred overnight
  • Hypoglycaemic episodes were not always managed appropriately as per trust guidelines
  • Several patients had recurrent hypoglycaemic events

They also identified some of the issues which were also linked to the condition which included:

  • Hypoglycaemia is potentially fatal – prompt recognition and appropriate management is required to particularly avert the risks of neuroglycopenia
  • Episodes of hypoglycaemia should be documented correctly and medical teams alerted in order to identify the underlying cause and take appropriate action.
  • Hypoglycaemia is one of most feared complications for patients with diabetes and so is a key limiting factor for good diabetic control

Following on from the original audit in 2015, a month-long audit was conducted on three of the renal wards to assess if the original audit was accurate and if so how could this be improved.

Results demonstrated that hypoglycaemia was indeed common (93 episodes) and that treatment and documentation did not fit with the Trust policy.

As a result of the data the team launched their campaign which involved prescribing two digestive biscuits to patients who had a bedtime glucose of <10mmols.

This was a collaborative campaign involving, not only the renal DSN, but the renal dieticians and pharmacists.

When re-audited it was found that hypoglycaemia had been reduced by almost two thirds (35) just by this simple innovation.