Introduction: Empirical research studies suggest that continuous glucose monitoring systems (CGMS) are safe and could optimize neonatal hypoglycaemia management. However, they need to be tested within resource-limited, time-constrained clinical practice. CGMS was piloted in our Level 3 Neonatal Intensive Care Unit (NICU) in June 2017. Five key barriers to its effective implementation were identified: i) Lack of NICU staff confidence in device usage ii) Infant discomfort during device removal iii) Calibration errors iv) Wireless connection disruptions during nursing cares v) Bruising after device removal. We designed a quality improvement project that aimed to reduce the number of problems per patient associated with CGMS use in our NICU from 5 to 0 over a one-month period.
Methods: This study was conducted from June-July 2017. Eligible for inclusion were term neonates 1.5 kg who were admitted for hypoglycaemia (<2.6 mmol/l) within the first 48 hours of life. A New Generation EnliteTM Sensor (Medtronic, Northridge, California) was inserted into five consecutive babies admitted with hypoglycaemia and removed when normoglycaemia was achieved. The sensor transmitted interstitial glucose readings to a MinimedR REAL-Time Transmitter and displayed glucose values every 5 minutes on a MiniMedR 530G System (both Medtronic, Northridge, California). Five Plan-Do-Study-Act (PDSA) cycles tested the change intervention.
Results: The first two cycles tested CGMS acceptability and practicality of the device using qualitative feedback from nursing staff and families and quantitative data from the Neonatal Infant Pain Scale (NIPS). Subsequent cycles focused on optimizing the insertion process, trouble-shooting calibration errors, and on promoting NICU staff confidence in device usage. Key recommendations included manually inserting the device on smaller babies, using Duoderm® to reduce subcutaneous bruising, timely insertion of calibration readings to avoid sensor errors, adaption of nursing cares to avoid signal loss, and using near-peer teaching techniques to educate medical and nursing staff on CGMS usage. Bland-Altman analysis comparing point-of-care and sensor glucose readings showed no significant proportional bias
Discussion: PDSA cycles revealed aspects of CGMS use that need to be adapted for its successful implementation in real-life clinical practice. Further studies should assess the potential of CGMS as a decision-making tool in hypoglycaemia management.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology