Clinical audit on in-patient diabetes care in a university medical unit

Introduction: Auditing is integral to recognising deficits in care and providing sustainable improvements. Auditing of in-patient diabetes care has not been practised in Sri Lanka despite its impact on patient outcomes. The objectives were to assess the quality of in-patient diabetes care at a University Medical Unit measured against the standards in 'National diabetes in-patient audit, UK' and American Diabetes Association. This was followed by implementing changes and re-auditing, completing the clinical audit cycle.

Methods: Data were retrieved retrospectively from medical records of in-patients with diabetes at the medical ward, University Hospital - KDU. Documentation of outpatient medications, appropriateness of blood glucose monitoring, achieved glycaemic control and medication management errors were assessed. The first cycle was conducted in August 2021, followed by remedial measures, including educating medical and nursing staff and introducing hypoglycaemia and blood glucose monitoring algorithms and a structured insulin prescription form. The second cycle was conducted in July 2022.

Results: Data were collected from 76 and 73 patient records in the first and second cycles, respectively. Outpatient medication regime was documented in 22 (28.9%) in the first cycle and 61 (83.6%) in the second cycle (p<0.001). Blood glucose monitoring was inadequate in 34.2% and 57.5% in the first and second cycles, respectively. Persistent hyperglycaemia was observed in 52.6% in the first cycle and 55.7% in the second. Ten patients had hypoglycaemia during the first cycle, while four incidences occurred during the second cycle. Medication adjustment for persistent hyperglycaemia was not performed in 50% and 43.6% of patients in the first and second cycles.

Conclusions: Unprecedented scarcity of resources during the second cycle posed limitations in glycaemic monitoring. Observed deficiencies in in-patient diabetes care that remained resistant to the remedial measures necessitate strong consideration of more proactive care improvement initiative