P2.N273: Do Visual Prompts and Education Improve Clinical Practice?

Purpose/Objectives: The study aimed to investigate whether visual prompts and staff education influence clinical practice related to blood glucose monitoring in acute paediatric presentations.

Design/Methods: All presentations of patients < 16 years to either Raigmore A&E or Paediatric Assessment Unit (PAU) across November 2021 were identified. Medical records were analysed for reason for presentation, specific risk factors, and any documented blood glucose result. Pre-hospital results were considered. Blood glucose results or omissions were then categorised as appropriate or inappropriate, based on pre-defined criteria and clinical discretion. A period of Emergency and Paediatric staff education with educational sessions and introduction of a poster to help identify when blood glucose monitoring is needed. The analysis was repeated for all acute paediatric presentations across November 2022 (a year after the baseline data was collected). Indications for blood glucose monitoring were adapted from NICE criteria (NG 51) and by consultant-led panel discussion [1].

Results: In November 2021, out of 798 children presenting to Raigmore Hospital, 21.4% underwent blood glucose monitoring. Among these, only 3.0% of blood glucose checks were deemed inappropriate, however 38.8% of omissions were categorized as 'missed.' Following the intervention period, in November 2022, 651 children presented to Raigmore Hospital, where there was a 10.4% increase in the total number of blood glucose tests conducted. The proportion of missed investigations decreased by 27.1%, but inappropriate checks rose by 6.2%.

Conclusion/Discussion: There has been significant progress in identifying high-risk patient groups for abnormal blood glucose levels in acute paediatric presentations. The significant reduction in the proportion of missed blood glucose checks reflects the positive impact of staff education and visual prompts, such as posters. The simultaneous rise in inappropriate blood glucose checks indicates a tendency to exercise greater caution. It is important to note that medical staff changeovers occur every four months, hence there may be a need for refresher education sessions for new staff. Further staff education, aided by effective posters, can significantly improve patient care.

References:
[1] NICE, 2017. Sepsis: recognition, diagnosis and early management. Accessed 16/09/23, https://www.nice.org.uk/guidance/ng51/resources.