Increasing the number of insulin doses that are given on time

Quality Improvement Poster Download

Background & Problem

From talking to patients on 7B it was established that insulin is not always given on time. Rapid/short acting insulin needs to be given just before or during meals, this ensures that the insulin starts working as the body’s blood sugar starts to rise. Giving insulin too late after a meal can cause the body’s blood sugars to spike. Spikes in blood sugars can cause diabetic complications over time.

Baseline data from reviewing a number of notes retrospectively showed that on 7B 48% doses are delayed, of which 28% of these doses had no documented time. It is crucial for the times to be documented in order for us to know whether doses are actually given on time.

Documentation problems regarding nurses signing for doses also presented themselves with 25% of doses not signed. Accurate documentation is a standard expected of nurses from both the trust and the Nursing and Midwifery guidelines.

Aim

To increase the number of insulin doses that are given on time. At least 80% of doses should be on time

Secondary aim – To improve the documentation of insulin administration. 100% of doses should be timed and signed

Time frame: 30th Nov 2017

Method

The team decided to look at why the doses were given late and the fact they were not signed or timed. I designed an audit which I performed every week over a number of months. This meant we could look at the percentage of doses that were late and why, and the standard of documentation. We used a number of PDSA cycles to improve the issues such as education, ward meetings, prioritising patients on the drug round and introducing self administration of insulin.

Results

Comparing the results against the baseline data 7B have improved overall with both giving doses on time and documentation.

Increasing the number of doses given on time - 8 weeks out of 17 over 80% of doses were given on time with 3 of those at 100%. It took over 4 weeks at the start of the project for the results to start reaching what was required .

Improving documentation – Majority of the 2nd half of the project showed a marked improvement with most of them being over 80% and four weeks of 100%.

The results regarding both delays in doses and documentation, there were a number of weeks where certain delays were out of the nurses’ control.

Self-administration was slow to pick up however we had 2 successful patients and a lot of the patients were not suitable.

Implications

The PDSA cycles have proved successful and I feel that these can be used on other wards in the future. The advantage is that they can be easily transferred to the other wards without a lot of preparation.

The lessons learnt were from the self administration PDSA, it was harder to implement as it is a significant change in practice and requires trust from both staff and patients. Next time I would involve the multi discipline team and ensure everybody is on board before starting this stage.

There are plenty of opportunities to extend; any ward that has a positive view of this subject matter can succeed.