title: Study of a structured action pathway and persistent monitoring tool among nurses to achieve cent percent management of hypoglycaemia in in-patients: A measure of quality of healthcare.
abstract: BACKGROUND
  Reporting and management of hypoglycaemia is a reflection of quality of healthcare delivery. The study evaluates success of a structured plan implemented in a tertiary care hospital in terms of an evidence-based hypoglycaemia management protocol, training and awareness among all nurses in the organisation to achieve 100% reporting of hypoglycaemia.
  
  
  METHODS
  A prospective study was conducted over a 3-year period. An in-house hypoglycaemia management protocol was designed, included in the induction training programme of nurses and implemented in wards under the guidance of master trainers. Each episode of hypoglycaemia was reported, managed and logged into centralised database, Quality Flash Matrix (QF). The QF was analysed at end of each 24 h cycle to carry out a root cause analyses and appropriate correction in training modules. Data were extracted from hospital records, patient case records and QF in terms of total number of cases receiving insulin and total number of episodes of hypoglycaemia documented and reported.
  
  
  RESULTS
  Incidence of hypoglycaemia recorded was 6.4, 5.3 and 4.7 per 1000 patient hours for the years 2011, 2012 and 2013, respectively. The percentage of episodes of hypoglycaemia reported improved from 78% (1st quarter 2011) to 100% (4th quarter 2012). Root cause analysis showed change in diet of patient with no corresponding change in insulin and vice versa being the commonest cause for hypoglycaemia consistent over the study period.
  
  
  CONCLUSIONS
  Constant structured training of nurses, constant surveillance and appropriate feedback analysis result in decreased incidence of hypoglycaemia and increased reporting of episodes of hypoglycaemia.
authors.affiliation: Head, Division of Nursing Quality, Education & Training, Max Healthcare Limited, New Delhi, India.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Mishra
authors.affiliation: Classified Specialist (Surgery) & Oncosurgeon, Base Hosptal, Delhi Cantt 110010, India.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Chauhan
authors.affiliation: Chief, Division of Endocrinology, Max Healthcare Limited, New Delhi, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Jha
keywords: Healthcare; Hypoglycaemia; Nursing; Quality outcome measure