Abstract:
Background: Hypoglycemia in young children can lead to serious complications, including neurological damage if not addressed promptly and can lead to delay in diagnosis of serious endocrine/ metabolic conditions (especially children < 2 years of age). Morbidity case: AC- 2y4mo, M-recurrent hypoglycemic episodes, 6 x ED presentations, missed ketones /hypoglycemia screen. Developed milestone regression and MRI Head changing.
Aims: Based on this morbidity case decided to do a QI Project, aiming to analyse the current practice of hypoglycaemia management in children presenting to hospital, identifying knowledge gap and introducing practical, sustainable action plans.
Method: (Plan-Do-Study-Act Cycles) The 1st cycle involved a retrospective data collection to assess current practice and management of children over the 6 months period (Sept 2024-Feb 2025),8 out of 20 children met the inclusion criteria (age 1 months to 2 years old, presented with biochemical hypoglycaemia (<3mmol/L) to Paeds ED/PAU. Neonates and already inpatient cases were excluded.
Results: Our study revealed only half of hypoglycaemic pts had ketones checked, 2/3rd had blood gas done and NONE had hypoglycaemia screen performed, which led to Urgent Need for a unified Management Pathway.
Discussion:
- MDT approach: Study findings were shared in the joint Paeds and Paeds ED M&M, raising awareness and action plans were discussed and approved for further PDSA Cycles
- Regional Hypoglycaemia Management in Children Guideline was reviewed and a local Guideline was created including in-house lab/sample requirement and Contact details
- New guideline was presented in Paeds Clinical Governance Meeting with pre and post presentation knowledge assessment and staff awareness
- Catchy Posters and sticker alerts(on all glucometers in Paeds areas saying BM<3, think ketones/hyposcreen), with staff feedback survey
- Periodic assessments of the practice and compliance check- as next cycle
