6468 Enhancing clinical effectiveness of neonatal hypoglycaemia screening – PDSA driven quality improvement project

Objectives To ensure that appropriate and timely investigations are prioritised and completed for persistent or severe hypoglycaemia in term and late-preterm neonates in a Local Neonatal Unit (LNU) as per BAPM hypoglycaemia guideline.1 Methods Three PDSA cycles were completed on hypoglycaemia screening for newborns >34-weeks gestation in 2017 (A1), 2019 (A2) and 2023 (A3) respectively in an LNU setting. Data was collected retrospectively from the electronic patient record (EPR), physical notes and laboratory data. The screening process was studied for adherence to Trust and BAPM guidelines. In cycle A1, the screen included an extended array of investigations with incomplete sampling and poor results. Consequently, the Trust guideline was amended and a visual aid was clearly displayed in the neonatal unit with images of different vacutainers and the respective investigations needed. In cycle A2, the screen investigations were streamlined to 'first-line' – those that needed to be done on priority at the time of hypoglycaemia, and 'second-line' – those that could be done later if needed. Education and training sessions for staff were conducted after both cycles A1 and A2. Results PDSA cycles A1, A2, and A3 evaluated 10, 8, and 18 hypoglycaemia screens, respectively. Across all cycles, 64% of screenings occurred on the first and second days post- birth, primarily in the neonatal unit, with 14–30% in the Emergency Department. Screen completion rates improved from 10% (A1) and 20% (A2) to 94% (A3). The laboratory rejection rate dropped by 36% from A1 to A3 but remained high at 44%. Common reasons for rejection included insufficient sample, wrong tube, and labelling errors. Cycle A3 still had 56% of screens resulting in unnecessary investigations. The sole diagnosis in accepted samples from all cycles was transient hyperinsulinism (100%). Figure 1 summarises the interventions carried out in each cycle and the trends of key results across all three cycles. Conclusion The screen completion rate showed an 84% improvement over three PDSA cycles. Although the laboratory sample rejection rate decreased, it remains high due to over- sampling and human errors in sample collection and transport. After cycle A3, our next action is to develop a comprehensive decision support algorithm for newborns requiring screening and incorporating bedside ketone testing. Additionally, we will establish an EPR order-set for 'first-line investigations' to facilitate streamlined and precise investigation requests. References British Association of Perinatal Medicine. Identification and Management of Neonatal Hypoglycaemia in the Full Term Infant. Framework for Practice April 2017. British Association of Perinatal Medicine. Identification and Management of Neonatal Hypoglycaemia in the Full Term Infant – DRAFT Framework for Practice April 2023.