Reporting hypoglycaemia as a hospital-acquired complication: assessing biochemical and clinical validity.

BACKGROUND AND AIMS: Given treatment-related hypoglycaemia in hospitals can lead to adverse outcomes, the Australian Commission on Safety and Quality in Health Care has included hypoglycaemia as a reportable hospital-acquired complication (HAC) with financial disincentives. However, the designation of a hypoglycaemia HAC relies on clinical coding without a defined glucose threshold or clinical context. We assessed the biochemical validity and clinical relevance of a hypoglycaemia HAC. METHODS: We performed a retrospective review on patients discharged from the Northern Health hospitals between March and August 2021 who were designated as experiencing a hypoglycaemia HAC. We assessed cases for biochemical validity (glucose <4.0 mmol), clinical context and whether they were treatment-related (treatment with insulin or sulphonylurea). We then compared this cohort with a hospital-wide glucometric survey based on a point-prevalence study to determine the proportion of individuals with hypoglycaemic events that were designated as hypoglycaemia HAC. RESULTS: Two hundred fifty-six admissions were coded as hypoglycaemia HAC. Eleven (4%) did not have a biochemically valid episode. Of the valid cases, 34 (14%) were not treated with any glucose-lowering medication and 11 (4%) were treated with noninsulin, nonsulphonylurea glucose-lowering medication. Two hundred admissions (78%) were considered treatment-related HAC. Of 139 individuals with diabetes identified in the hospital-wide point-prevalence study, 25 (18%) had biochemical evidence for hypoglycaemia: 22 were treatment-related, of which 68% were not coded as HAC. CONCLUSION: Given safety and cost implications, the designation of hypoglycaemia HAC requires a standardised definition incorporating a biochemical threshold and clinical context. We propose a clinically relevant definition of hypoglycaemia HAC to promote safe diabetes care.

Smoking cessation therapy in Australian and New Zealand intensive care units: a multicentre point prevalence study.

OBJECTIVE: To obtain an accurate estimate of smoking prevalence and smoking cessation support practices, including nicotine replacement therapy (NRT), in Australian and New Zealand intensive care units (ICUs). DESIGN, SETTING AND PARTICIPANTS: Cross-sectional, observational study using data obtained from adult ICUs participating in the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program in 2016. MAIN OUTCOME MEASURES: Prevalence and intensity of current smoking, baseline characteristics of smokers in comparison with non-smokers and frequency of NRT use while admitted to the ICU. RESULTS: Smoking data were present for 551 of 671 adult ICU patients from 47 ICUs on 2 study days in 2016. Of these 551 patients, 112 were current smokers (20.3%; 95% CI, 17.0-23.9%). No significant differences in severity of illness or mortality were observed between smokers and non-smokers. NRT was prescribed to 30/112 smokers (26.8%), and in 28 of those 30 patients (93%) it was administered via nicotine patch alone. Routine prescribing of NRT was practised in 28/47 ICUs (60%), and 24/47 ICUs (51%) had formal protocols or guidelines in place related to supporting smoking cessation. CONCLUSIONS: The prevalence of smoking in Australian and New Zealand ICUs patients is high. Over half of participating ICUs reported the routine prescription of NRT despite uncertainty regarding the practice. Further research evaluating the safety and efficacy of NRT is required.