Authors: Yadagiri M, Burbridge W, Leong WB, Munichoodappa K, Robinson M, Braycotton L, Mukhopadhyay S, Ilsley D, Kaur A, Puttanna A and Parijat De
Aims: To evaluate management of diabetic ketoacidosis (DKA) before and after introduction of a new abbreviated trust DKA guidelines in Sandwell and West Birmingham NHS Trust (SWBHT).
Methods: Retrospective review of DKA admission case notes using a revised SWBHT DKA guideline (introduced Aug 2015). An audit proforma was used to evaluate each patient’s diagnosis, assessment of clinical severity and management of DKA. Out of 55 DKA admissions from May 2015 – Aug 2016, 33 (60%) were reviewed.
Results: Mean admission to diagnosis time of DKA fell by 58min (135 to 77 min), admission to initiation of fixed rate intravenous insulin infusion time fell by 106 min (177 to 71 min), admission to initiation of IV normal saline time fell by 18 min (93 to 75 min), time for resolution of DKA improved by 1hr 10min (16.9 to 15.8 hours) and length of stay of DKA admission fell by 4.3 days (7.5 to 3.3 days). There was a 23% and 29% improvement respectively in basal insulin continuation and use of 10% dextrose when BM was <10mmol.
Junior doctor survey: 20/26 (77%) felt the protocol was helpful, 16/25(64%) found it easier to use and 17/25 (68%) found it made DKA management easier.
Conclusions: The overall clinical management of DKA in the trust has improved significantly since the new DKA protocol was introduced including reduction in length of stay and improved user satisfaction. Our revised DKA protocol can be easily adopted nationally.