ABSTRACT
The early stage of wave 2 in SJH was a very busy and rapidly evolving situation for the medical team. Dexamethasone and remdesivir had recently been introduced into clinical practice following RECOVERY trial results. High clinical demand, and a rapid turn-over of junior medical staff in the COVID wards meant unfamiliarity with the treatment. My COVID Bundle was designed as a support tool for medical staff in safely managing patients who tested positive for COVID-19 to: 1. Improve easy to see documentation of target oxygen saturations in patients with COVID-19 disease 2. Improve the monitoring of blood sugars when patients were started on dexamethasone for COVID-19 disease Thirty covid positive patients were included in the initial baseline data collection from the medical wards. Of these, only four (13.3%) had clear documentation of target oxygen saturations. Fifteen were commenced on dexamethasone, of which seven (46.7%) had appropriate monitoring of their blood sugars. A series of interventions were then implemented. Initially I created a ‘COVID Bundle’ for patient’s bedside notes which prompted staff on 1) target oxygen saturations, 2) escalation status, 3) resuscitation status, 4) checking BMswhen on dexamethasone. I then updated and combined my COVID Bundle with a COVID treatment poster, which was placed in all ‘red’ patient notes. I had several rounds of data collection during the series of interventions. The clear documentation of target oxygen saturations increased from 13.3% to 100%, while appropriate monitoring of BMsincreased from 46.7% to 93.3%. The management of COVID-19 is an ever evolving area, which can be difficult for both medical and nursing staff to keep up with in an ever busy working environment. This small scale QIP shows that the ‘COVID Bundle’ is a useful aid for staff in the safe management of patients with COVID-19.
ABSTRACT
Aims: The use of dexamethasone has increased since its benefit in treating covid-19 was discovered. Hyperglycaemia has been shown to be associated in poorer outcomes in patient with covid-19. The aim of this audit was to improve monitoring and management of hyperglycaemia in covid-19 patients on dexamethasone. Methods: In October 2020 the notes of ten patients on dexamethasone for covid-19 were audited over a 1-week period to determine if they had a glucose chart present, if they were having glucose checked four times daily, and if raised glucose was appropriately actioned upon. Following this a covid-19 bundle was created to improve management of covid-19. This included guidance on monitoring and treatment of hyperglycaemia, with an aim for this to be placed in all patients notes with confirmed covid-19. The bundle was based on covid:Diabetes guidance from the national inpatient diabetes covid-19 response team. Re-audit was then performed in January 2021 for a total of seven patients. Results: In October 2020 80% of patients were having their glucose levels checked, improving to 100% by January. Appropriate frequency of checking glucose improved from 20% to 57%. Appropriate actioning of hyperglycaemia, if required, improved from 50% to 75%. Conclusion: Providing local education regarding the guidelines for dexamethasone associated hyperglycaemia in covid- 19 patients can improve both management and monitoring of hyperglycaemia. Ongoing education is required for both medical and nursing staff to ensure ongoing development in recognition and management of hyperglycaemia.