A feed-centric hypoglycaemia pathway ensures appropriate care escalation in at-risk infants

BMJ Open Quality

article

Suresh Chandran¹  Jia Xuan Siew⁴  Victor Samuel Rajadurai¹  Rachel Wei Shan Lim⁵  Mei Chien Chua¹  Fabian Yap² 

[1] Department of Neonatology , KK Women's and Children's Hospital;Paediatric Academic Clinical Programme , Lee Kong Chian School of Medicine;Paediatric Academic Clnical Programme , Duke NUS Medical School;Division of Medicine , KK Women's and Children's Hospital;Department of Medicine , Tan Tock Seng Hospital;Division of Paediatric Endocrinology , KK Women's and Children's Hospital

关键词: diabetes mellitus;    healthcare quality improvement;    paediatrics;   

DOI  :  10.1136/bmjoq-2020-001296

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background There is a lack of clarity of what constitutes the starting point of a clinical pathway for infants at-risk of hypoglycaemia. Glucose-centric pathways (GCP) identify low glucose in the first 2 hours of life that may not represent clinical hypoglycaemia and can lead to inappropriate glucose management with infusions and medications.Objective To study the impact of a feed-centric pathway (FCP) on the number of admissions for hypoglycaemia to level 2 special care nursery (SCN) and the need for parenteral glucose/medications, compared to GCP.Methods This project was conducted over 2 years, before and after switching from a GCP to FCP in our institution. FCP involves skin-to-skin care, early breast feeding, checking glucose at 2 hours and use of buccal glucose. The primary outcome was the number of SCN admissions for hypoglycaemia. Secondary outcomes include the number of infants needing intravenous glucose, medications and length of SCN stay.Results Of 23 786 live births, 4438 newborns were screened. We screened more infants at-risk for hypoglycaemia using the FCP (GCP:1462/11969, 12.2% vs FCP:2976/11817, 25.1%) but significantly reduced SCN admissions (GCP:246/1462, 16.8% vs FCP:102/2976, 3.4%; p<0.0001). Fewer but proportionally more FCP newborns required intravenous glucose (GCP: 136/246, 55% vs FCP: 88/102, 86%; p=0.000). Compared with GCP, FCP reduced the total duration of stay in SCN by 104 days per annum, reducing the cost of care. However, the mean length of SCN stay for FCP was higher (GCP:2.43 days vs FCP:3.49 days; p=0.001). There were no readmissions for neonatal hypoglycaemia to our institution.Conclusion The use of FCP safely reduced SCN admissions, averted avoidable escalation of care and helped identify infants who genuinely required intravenous glucose and SCN care, allowing more efficient utilisation of healthcare resources.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND