Background
The adult subcutaneous insulin chart used at our site did not meet escalation requirements for blood glucose level (BGL) or blood ketone monitoring during pregnancy necessitating the development of a specific obstetric chart.
Objectives
To create and implement an obstetric specific subcutaneous insulin chart with safety features embedded within, consistent with the National Subcutaneous Insulin Chart. Additionally to assess the management of women with Gestational Diabetes (GDM) admitted for delivery pre and post implementation of our Obstetric Subcutaneous Insulin Chart.
Method
A retrospective review was performed of 103 medical records of women with GDM admitted for delivery to our service between February 2015 and March 2016. Variables audited included blood glucose level (BGL) and blood ketone monitoring, frequency and safety of insulin prescribing, frequency of hypoglycaemic and hyperglycaemic events. Continuous variables were compared using t-tests and categorical variables were compared using Fisher’s Exact tests.
Results
An increase in chart usage was observed post implementation of the obstetric chart (76.5% vs 98.6%; p<0.001). Documentation of admission BGL (50.0% vs 80.9%; p=0.004) and blood ketone levels (15.4% vs 47.1%; p=0.005) improved post chart implementation. There was a low rate of intrapartum hyperglycaemia with no significant difference in patients experiencing BGL ≥7.1 mmol/L. No change in incidence of hypoglycaemia was noted with chart implementation (23.1% vs 30.9%; p=0.611). Intrapartum insulin prescribing increased with chart implementation (7.7% vs 29.4%; p=0.030) and overall prescribing of insulin was deemed safe and appropriate.
Conclusion
Introduction of an obstetric subcutaneous insulin chart was associated with increased chart usage and insulin prescription. Documentation of admission BGL and ketones improved, however remained suboptimal. Further education and evaluation is required to ensure optimal use of the chart.