Authors (including presenting author) :
Ip SM(1), Yip LW(1), Lau YL(1)
Affiliation :
Department of Medicine, YCH
Introduction :
In the past, as the glycemic condition of the patient with Diabetes Mellitus are stable and under well-controlled, the routine bedside glucose monitoring will be obsoleted after transfer to Medical Extended Care Unit. However, for some frail elderly patients, their physical condition is fluctuated according to the appetite and mood depression. Thus, the glycemic monitoring is important to detect the early sign of hypoglycemia as well as hyperglycemia, which is helpful to prevent fatal consequence.
Since 16 August 2021, a protocol-driven bedside blood glucose monitoring for selected DM elderly patients was piloted. It is a nurse-initiated program to conduct blood glucose test monitoring one day per week aiming to monitor patients’ blood glucose level in order to detect any abnormal changes without early signs of discomfort and enhance clinical outcomes.
Objectives :
Through regular monitoring and timely detection, we aim:
1. To ensure patient safety and quality of care by early detection of any blood glucose changes
2. To avoid hypoglycemia & hyperglycemia episode
3. To minimize the unnecessary hospital length of stay
Methodology :
Target group are all diabetes mellitus patients who are being transferred to medical extended care unit, no matter they are:
1. On insulin therapy or
2. On oral or injectable antidiabetic medications or
3. All insulin therapy or antidiabetic medications has been stopped
Exclusion criteria for those who are nil by mouth
Blood glucose monitoring is performed for selected patient who are on oral feeding or NG feeding.
Bedside blood glucose monitoring will be performed in one scheduled day, one full day per week before each meal/ feed.
If the blood glucose level is abnormal, <3.9 mmol/L or >10.0 mmol/L, nurse would inform doctors for reviewing and adjustment of diabetic medication as required. For therapy assessment and prognostication, hemoglobin A1c testing is recommended for those long stay patients.
Result & Outcome :
During the pilot period, 16 patients were recruited. 4 (25%) were detected for abnormal results: 1 (6%) was detected for hypoglycaemia; 3 (19%) were detected for hyperglycaemia.
In such, it is strongly recommended that nurses should demonstrate a more proactive and supervision role on these frail elderly patients to monitor their precipitating changes of abnormal blood glucose level with any signs and symptoms.
