Accessibility and adherence to clinical guidelines on diabetic emergencies during the covid-19 pandemic: A survey to connect with healthcare professionals via digital platforms

ABSTRACT

Aims: The covid-19 pandemic has brought many challenges to medical training and education. Clinical guidelines are an important resource especially for redeployed healthcare professionals (HCPs) to manage diabetes emergencies. Our aim is to understand how non-specialist HCPs prefer the diabetic ketoacidosis (DKA) and hyperosmolar hyper-glycaemic state (HHS) guidelines to be presented to improve accessibility and adherence. Methods: An online survey was conducted in January 2021, using a QR code to access the survey via digital platforms including email, posters and MS teams. Results: Among the 101 responders, 42% were core-medical or trust-grade doctors, 22% foundation year 1 doctors, 17% higher specialty trainees and the remainder nurses, healthcare assistants, pharmacists and consultants. Despite online access to national-based trust diabetes guidelines, only 17% of surveyed HCPs were confident in prescribing and administering treatment for DKA or HHS. 92% responders had managed DKA or HHS more than once in the last 6 months. Despite the majority (88%) knowing where to access the current guidelines, only 13% of prescribing responders followed the guideline in prescribing regular basal insulin with fixed-rate intravenous insulin infusion. 88% preferred a pre-printed proforma of the guideline with examples of model prescriptions. Most useful features rated were flowcharts (76%), checklists (72%), criteria for escalation (62%) and model prescriptions (58%). Guidance on fluid management, especially in renal and heart failure, was most frequently requested. Conclusions: An online survey with QR code access has facilitated a good response and has allowed diabetes emergency guidelines to be tailored to the needs of non-specialists during the covid-19 pandemic.