An Audit on Glycosylated Haemoglobin & Fasting Plasma Glucose Blood Tests Done on Admission to an Older People's Inpatient Ward

AIMS: The aim of this study was to determine the proportion of patients who had fasting plasma glucose and glycosylated haemoglobin (HbA1c) blood tests done on admission to an older people's inpatient ward at Kingfisher Court, Hertfordshire. Patients undergo a physical health assessment when they are admitted to the ward. This consists of a physical examination, an electrocardiogram and a panel of blood tests, which include a fasting plasma glucose and HbA1c. Given that people with severe mental illness have a greater burden of physical health conditions, such as diabetes, this physical health assessment can aid in optimising patients’ physical health and reducing this health inequality. METHODS: A sample of 40 patients who were most recently discharged from the older people's inpatient ward were included in the audit. Four authors each independently reviewed 10 patient case notes and blood results. An audit collection tool was produced and data logged for each patient. The data collected were reviewed by all authors. RESULTS: 57.5% (23) of the study population had admission blood tests that included a HBA1c level or plasma glucose. An individual with diet-controlled type 2 diabetes mellitus had a HBA1c of 55 mmol/mol and was subsequently started on metformin. Only 15% (6) of the study population had a plasma glucose test on admission. Their case notes did not specify whether these were fasted or random plasma glucose tests. 42.5% (17) of the study population did not have either a plasma glucose test or HBA1c test done. CONCLUSION: There was poor overall compliance with the trust protocol for blood tests on admission to the older people's inpatient ward. Plasma glucose tests were rarely done and it was not specified whether they were fasted or random tests, thus limiting their utility. The team therefore suggest that the fasting plasma glucose test be removed from the panel of admission blood tests. The focus should be on obtaining a HbA1c test. Amendments to the clerking proforma and doctors’ induction presentation should be made to emphasise the importance of the HbA1c test.