Summary

During a hospital stay, around one-in-four people with diabetes suffers a hypoglycaemic. Not only is this likely to increase length of stay and associated costs, but it is also associated with increased mortality.

Hypoglycaemia is treated inconsistently across the country, within Trusts and even between the wards of an individual hospital. Symptoms of hypoglycaemia may not be recognised until they become severe.

BBI Healthcare wanted to work with NHS Trusts to improve and reduce the number of hypoglycaemic episodes experienced by inpatients with diabetes. In January 2008 it launched an initiative to deliver a “one-stop” hypoglycaemia management first aid box to customers – and the HypoBox was born.

Results

Staff uptake, use and understanding of the HypoBox is measured through audit, supported by patient record books from the HypoBox. This allows evaluation of the initiative and shows if update training is needed.

Overall, the HypoBox Hypoglycaemia Management package has been implemented across over 50 hospital trusts in the UK. There has also been significant success within primary care and care homes.

NHS Bury was the first PCT/Community Diabetes Service to implement the HypoBox initiative with around 140 boxes being rolled out to district nursing teams.

HypoBox is a registered trademark

Challenge

The main objective of the initiative was to improve inpatient management of hypoglycaemia by educating staff and placing HypoBoxes on hospital wards. Crucially, they wanted to encourage an audit of initial implementation, enabling the project to be measured, monitored and reviewed in light of audit results.

Solution

The HypoBox was developed by BBI Healthcare and contains measured doses of fast-acting carbohydrate for mild to moderate hypoglycaemia, along with a ‘space’ for the Glucagon Hypokit to be stored.

The HypoBox also contains a laminated treatment pathway to remind ward staff of the signs and symptoms of hypoglycaemia along with the appropriate treatment to be delivered.

As part of the initiative BBI Healthcare developed training materials that can be adapted to meet local requirements across multidisciplinary settings. This developed into the Hypoglycaemia Management Package.

Patient support and education materials include a hypoglycaemia DVD, hypoglycaemia education sheets and ‘I have Diabetes Cards’.

Account managers from BBI Healthcare work with diabetes specialist nurses (DSNs) and hospital pharmacists in hospitals or Trusts to implement the Hypoglycaemia Management Package. They establish the level of knowledge among staff and factor in local guidelines and requirements for education, training and implementation so they can adapt the tools to local needs.

All training is reinforced by the inclusion of treatment pathways contained in the HypoBoxes, which can also be supported by treatment pathway posters placed on wards.