MON-011 Improving Glycemic Control and Management of Enterally Fed Stroke Patients with Diabetes

Background & Aims: Despite poor glycemic control being associated with worse neurological outcome in stroke patients, there remains considerable variability in management. This quality improvement project was conducted to evaluate the current practice of glycemic management in the enterally fed stroke patients against the JBDS guidelines and improve the glycemic control in these patients. Methods & Results: First PDSA Cycle⋯This involved data collection regarding glycemic control in enterally fed stroke patients with diabetes on stroke wards, focusing on the referral to DSN and dietician, documentation of carbohydrate content in the notes, monitoring of blood glucose levels, management in case blood glucose levs were out of range. The cycle confirmed that although in most cases, there were timely referrals to dieticians in all cases and DSN in many cases, the monitoring and management of glycemic excursions was suboptimal in all cases. (15 episodes of glucose reading being outside of range in 6 patients, no action taken except in 3 episodes when BG>22mmol/l, BG monitored 4 times per day but did not correspond to guidelines which state pre-feed, 4-6 hourly when on feed and hourly if feed unexpectedly switched off) Second PDSA Cycle. Awareness around glycemic management among medical and nursing staff. A two-page document based on recommendations of Joint British Diabetes Society has been prepared and was circulated by email and posted in the ward. It will also be discussed in weekly departmental meeting. Monitoring was done for a further two weeks and then design blood glucose monitoring chart based on JBDS guidelines. PDSA 3. A proforma was designed which after pilot testing and feedback was incorporated in the normal BG monitoring chart. The intervention produced significant improvements in dietician referrals (75% to 100%), diabetic specialist nurse referral within 24 hours(50% to 87.5%), adequate blood glucose monitoring as per guidance(37.5% to 75%), number of patients with blood glucose in range(25% to 62.5%) and action on out of range blood glucose(0% to 66.6%). In conclusion, awareness exercise, provision of guideline summary and introduction of special proforma for enterally fed patients improved compliance with JBDS guidelines and glycemic profile of enterally fed stroke patients with diabetes.