Making surgical wards safer for patients with diabetes: reducing hypoglycaemia and insulin errors.

High-quality perioperative diabetes care is essential to improve surgical outcomes for patients with diabetes. Inadequate perioperative diabetes care is associated with increased wound complications, higher mortality rates and increased length of hospital stay. Despite national guidelines, surgical wards remain a high-risk area for poor diabetes care. An initial baseline audit in 2014 of vascular patients with diabetes undergoing major lower limb amputation identified poor glycaemic control in 90% of patients, with high rates of hypoglycaemia and insulin management errors in 75%. Less than 15% of patients received specialist diabetes input and 20% required third-party assistance for hypoglycaemia. This quality improvement project aimed to reduce hypoglycaemia, insulin management errors and patient harm events by 50% in vascular surgery patients over a 3-year period. Key interventions over three successive Plan, Do, Study, Act cycles included educational and guideline initiatives (2015), establishing a diabetes in-reach service (2016) and implementing a whiteboard sugar cube alert system for poor glycaemic control (2017). The final introduction of the whiteboard sugar cube alert system delivered the greatest impact in reducing hypoglycaemia rates by more than 50%, insulin management errors by 70% and patient harm events by 75%.