Mimi Wong is a Basic Physician Trainee
The Effect Of Implementing A Diabetes Ketoacidosis Management Protocol In A Regional Centre
Mimi Wong, Cairns Hospital, Queensland, Australia
Sarah Blyth, Cairns Hospital, Queensland, Australia
Anneline Helms, Cairns Hospital, Queensland, Australia
Anna McLean, Cairns Hospital, Queensland, Australia
Ashim Sinha, Cairns Hospital, Queensland, Australia
Aims: To determine the effect of implementing the Queensland health statewide diabetes ketoacidosis (DKA) management protocol.
Methods: A retrospective clinic audit was conducted at Cairns Hospital. DKA management, prior to the implementation of the DKA protocol, was examined between December 2013 and December 2014 (2014 cohort). After the DKA protocol was implemented, patients admitted between April 2016 and April 2017 were focused (2016 cohort). All information was obtained from electronic records.
Results: 106 patients were included in this study (n=54 from 2014; n=52 from 2016). Administration of the appropriate rate of intravenous (IV) fluids improved from 14.8% in 2014 to 34.7% in 2016 (p=0.019), however time to commencement of fluids did not significantly change, in 2014 it was commenced at 61+65 minutes and in 2016 it was started at 48+74.2 minutes (p=0.999). The administration of insulin infusion did not significantly change between 2014 and 2016. Time to commencement of insulin infusion was 73+108.9 minutes in 2014 and 63+114.65 minutes in 2016 (p=0.785), and an appropriate initial rate of insulin infusion occurred in 8.2% in 2014 and 13.5% in 2016 (p=0.393). In addition more than 50% of patients in 2014 and 2016 were managed with IV insulin for more than 24 hours (p=0.591). Investigations including chest x-ray (p=0.004) and blood culture (p<0.05) collection improved post-implementation of the DKA protocol, though urine MCS collection did not (p=0.262). Post-implementation of the DKA protocol, the emergency department triage category (p=0.035) and the administration of DVT prophylaxis (p<0.05) also improved and there was increased intensive care unit referrals (p=0.047). Aspects such as length of stay, recurrent admissions and endocrine referral did not appear to significantly change.
Conclusions: This study found that multiple areas concerning the inpatient management of DKA had improved post-implementation of a stratified DKA protocol. However there are still several areas where management could be strengthened, to further improve the care of patients admitted with DKA.