AIMS:The joint consensus of the American Diabetes Association and the European Association for the Study of Diabetes highlights the need for practical, up-to-date training in acute diabetes care. Therefore, this session aimed to develop an applied learning intervention that identifies key gaps in acute diabetes training, assesses participants' change in confidence in managing these scenarios following the intervention and evaluates participants' satisfaction and the intervention's relevance to practice. METHODS:To design the programme, we adopted Kern's six-step curriculum development framework. Clinical experts were interviewed to assess general needs, and students and resident doctors were interviewed to assess targeted needs. The SIMBA (Simulation via Instant Messaging for Bedside Application) model was adopted to develop cases alongside generative AI and expert input. Pre- and post-session surveys assessed participants' confidence, while the latter also assessed satisfaction and relevance to practice. RESULTS:33 participants attended the session. 17 participants completed both pre- and post-session surveys and were included in the study. Simulation performance scores averaged 4.0/5 for history taking, interpretation and clinical judgement; 3.9/5 for physical examination and investigations; and 3.6/5 for management. Confidence in managing acute diabetes scenarios improved significantly (pre vs. post: 33.3% vs. 78.4%, p < 0.001). 94.1% strongly agreed the cases were relevant, and 82.3% preferred this teaching method over traditional approaches. CONCLUSION:The model identified the need for targeted education on physical examination, investigations and management specific to acute diabetes scenarios. Simulation-based education significantly enhances confidence and is perceived as highly relevant for training in acute diabetes management.

Variable rate intravenous insulin infusions (VRIII) are frequently used in hospitals and incorrect use can lead to electrolyte imbalance, hypoglycaemia and adverse outcomes. The Joint British Diabetes Societies (JDBS) published guidelines in 2014 and recommended the use of a balanced fluid as substrate. There was no published data to demonstrate the superiority of this fluid in reducing adverse events. This quality improvement project aimed to review the existing practice at our Trust in accordance with JDBS guidelines. We predicted introducing this fluid would reduce adverse events and demonstrating this was a prerequisite condition from our Trust Medicines Management Committee to approve its long-term availability. We carried out an audit of our practice in 2015, at which time the JBDS recommended fluid (0.45% sodium chloride/5% dextrose with 0.15% potassium chloride) was not available in our Trust. Our VRIII guideline was re-written with recommendation for use of the balanced fluid, after procurement from pharmacy. Our primary areas for improvement as highlighted from the 2015 audit were correct substrate prescription and rate reduction of hypokalaemia (potassium <3.5 mmol/L) and hypoglycaemia (glucose <4 mmol/L) during VRIII use. Analysis of the pre-intervention (December 2016) and post-intervention (September-November 2017) data showed a significant increase in correct fluid use; 11% pre-intervention to 76% post-intervention (chi(2), p<0.0001). The number of hypoglycaemic events per VRIII reduced from 0.73 (+/- 1.78) to 0.28 (+/- 0.84) (p<0.05) peri-intervention. Similarly, the number of hypokalaemic events per VRIII reduced from 0.15 (+/- 0.54) pre-intervention to 0.05 (+/- 0.25) post-intervention. There was also a significant reduction in number of VRIII episodes associated with a hyponatraemia event from 26% at baseline to 12% post-intervention (p<0.01). Some of these marked improvements were not sustained at 1-year post follow-up. We reduced adverse outcomes with a substantial net-cost saving during this period, through implementation of new and accessible guidelines, trust-wide education programmes and posters to raise awareness.

AimsA quality improvement project undertaken at University Hospital Birmingham to improve the management of patients on variable rate intravenous insulin infusions (VRIII) to allow a consistent standard of care in keeping with Joint British Diabetes Societies guidelines. MethodsAn initial baseline of data was identified from the database; any episode where a patient was started on a VRIII over a 10-week period from 1 September to 10 November 2016.ITU patients and those on a scale for less than 1 hour were excluded.These were then analysed against three subsequent 2-week cycles of data in January, February and March 2017.Analysed data included demographics, length of VRIII, adherence to continuing longacting insulin/stopping other diabetic medication, frequency of blood glucose measurements, fluid and potassium administration and episodes of hypoglycaemia and electrolyte imbalance.Action changes were implemented between cycles.After the baseline data were collected, the results were presented at the grand round.After the first cycle new trust guidelines were approved and released on the intranet.Following the second cycle, the guidelines were distributed as posters across the hospital and along with formal clinical staff education.

Steroid-induced hyperglycaemia (SIH) is a common adverse effect in patients both with and without diabetes. This project aimed to improve the screening and diagnosis of SIH by improving the knowledge of healthcare professionals who contribute to the management of SIH in hospitalised patients. Monitoring and diagnosis of SIH were measured in areas of high steroid use in our hospital from May 2016 to January 2017. Several interventions were implemented to improve knowledge and screening for SIH including a staff education programme for nurses, healthcare assistants and doctors. The Trust guidelines for SIH management were updated based on feedback from staff. The changes to the guideline included shortening the document from 14 to 4 pages, incorporating a flowchart summarising the management of SIH and publishing the guideline on the Trust intranet. A questionnaire based on the recommendations of the Joint British Diabetes Societies for SIH was used to assess the change in knowledge pre-intervention and post-intervention. Results showed an increase in junior doctors’ knowledge of this topic. Although there was an initial improvement in screening for SIH, this returned to near baseline by the end of the study. This study highlights that screening for SIH can be improved by increasing the knowledge of healthcare staff. However, there is a need for ongoing interventions to sustain this change.

To assess the current knowledge and practice for monitoring and diagnosis of steroid-induced hyperglycaemia (SIH) in hospitalised patients. This study was undertaken on six wards with high frequency of steroid use – oncology, respiratory and neurology – at a large tertiary care centre in the