{
  "abstract": "Background Many patients at St Michael’s Hospice have diabetes or are prescribed steroids for symptom management. A lack of clear guidance and inconsistent blood glucose monitoring was observed on the inpatient unit (IPU). Timely identification and management of elevated blood glucose can prevent distressing symptoms and avoid potential life-threatening complications (End of life guidance for diabetes care. Trend Diabetes; 2024).Aim To improve blood glucose monitoring of patients with diabetes and/or prescribed steroids on the IPU, by establishing clear guidelines.Method Guidelines were developed using resources from Diabetes UK (End of life guidance for diabetes care. Trend Diabetes; 2024), SPAGG (Turley. A guideline for management of diabetes in Palliative Care. Specialist Palliative Care Audit and Guideline Group Agreed Documentation. 2022), and the Palliative Care Formulary (Wilcock, Howard, Charlesworth. (eds.). 8 th ed. Pharmaceutical Press; 2022).Cycle 1 reviewed blood glucose monitoring practices in 79 admissions between January and December 2024 and compared them to the guidelines. Interventions included:A flow chart in the MDT room, illustrating the monitoring guidelines.A ‘Blood Glucose Monitoring’ section added to the medical admission proforma.Cycle 2 reviewed 31 admissions between January and April 2025, to analyse post-intervention outcomes.Results Cycle 1:29% followed monitoring guidelines; 44% had frequency documented.55% of diabetic patients were monitored appropriately; 31% lacked home regimen documentation.13% of steroid-only patients met monitoring standards, with 9 patients monitored less frequently and 17 not at all. 14 had unnecessary daily testing.8 significant events occurred: four required interventions and three involved the diabetes team.On APOC (Achieving Priorities of Care), diabetes medications and monitoring were stopped for all. For 2/4 patients, insulin and daily monitoring should have continued. Steroids were stopped for 18/30 patients; 11/12 continuing steroids had no further monitoring.Cycle 2:71% met monitoring standards; 97% had documentation.8/10 diabetic patients were monitored appropriately; two lacked home regimen documentation.65% of steroid-only patients met standards; 30% partially met them. There was no unnecessary testing.On APOC, insulin and monitoring were appropriately continued in 2/2 cases. Steroids were stopped for 50% and monitoring stopped for all.Conclusion Clear guidelines improved monitoring consistency and reduced unnecessary testing. Monitoring should remain individualised based on patient needs.Further Improvements Recording home monitoring regimens, implementing reminders for steroid-related monitoring, and providing guidance on steroids during APOC reviews.",
  "authors": [
    {
      "affiliations": [
        "St Michael’s Hospice, Basingstoke, UK"
      ],
      "name": "Cecily Bloom"
    },
    {
      "affiliations": [
        "St Michael’s Hospice, Basingstoke, UK"
      ],
      "name": "Emily Price"
    },
    {
      "affiliations": [
        "St Michael’s Hospice, Basingstoke, UK"
      ],
      "name": "Talha Sadiq"
    },
    {
      "affiliations": [
        "St Michael’s Hospice, Basingstoke, UK"
      ],
      "name": "Jemma Storrar"
    }
  ],
  "title": "P-62 Blood glucose monitoring in the hospice setting – a closed loop audit",
  "uid": "f50481e5-3296-5b8f-93af-5ad1c713cdcc"
}