PSUN220 Audit on Variable Rate Intravenous Insulin Infusion (VRIII) in inpatients in Scarborough General Hospital

INTRODUCTION: A Variable Rate Intravenous Insulin Infusion (VRIII) is an infusion of insulin at an interchangeable rate. It involves taking regular capillary blood glucose levels, aiming to control the serum glucose levels with in a specific range and an infusion of glucose containing fluid to prevent insulin induced hypoglycaemia (1). A VRIII is used in patients with known diabetes or with hospital related hyperglycaemia who are unable to take oral fluids/food and for whom adjustment of their own insulin regime is not possible (1). The advantage of a VRIII is the fact is that it involves target driven glucose control for specified indications and avoids metabolic decompensation. AIM: To test the compliance of the ward medical staff with VRIII protocol against the local trust policy and the Joint British Diabetes Society guidelines (JBDS). METHODOLOGY: A retrospective audit on sample of 15 patients at Scarborough General Hospital receiving VRIII on medical and surgical wards. Data was collected over a period of a month. Data collection and analysis performed utilising Microsoft Excel. Audits standards based on trust guidelines and JBDS guidelines. RESULTS: Most patients were above age of 60 years, female and type 2 diabetic. 100% of patients had daily electrolytes monitoring, 27% had hypoglycaemia, 13% did not have long-acting insulin started before stopping the VRIII. In 40% of patients, blood glucose levels were not maintained between 6-12 mmol/L. Furthermore, in 13% of patients, blood glucose was not monitored hourly. CONCLUSION: This audit showed a good compliance with daily electrolytes measurement, early referral to diabetic team as well as starting the VRIII with dextrose. It is concerning however that integral measures such as ruling out DKA, not prescribing the correct fluid, not checking blood glucose levels and lowering the incidence of hypoglycaemia were not always present. Overall, this audit has identified areas required for improvement to optimise our compliance with VRIII protocol against local and national guidelines. We hope this can be improved via spreading greater awareness of the VRIII protocol, to promote early recognition of DKA and ensure safety checks occur when applying the VRIII protocol. REFERENCES: George, S., 2022. JBDS-IP The use of Variable Rate Intravenous Insulin Infusion (VRIII) in medical patients. Joint British Diabetes Society. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.