2001-P: From Knowledge to Action: A Quality Improvement Initiative to Guide Home Ketone Management in Pediatric Diabetes

Introduction and Objective: Diabetes ketoacidosis prevention requires timely ketone management during illness, pump site failures, and insulin omission. Despite routine education, many families rely on emergency call lines before initiating self-management. We aimed to improve patient self-efficacy and reduce ketone-related calls through individualized, evidence-based ketone action plans (KAPs). Methods: Guided by the Model for Improvement, we performed root cause analysis and subsequently developed and implemented KAPs for insulin pump and multiple daily injection users in a large pediatric diabetes center. Process measures included provider documentation of KAPs and provider feedback. Outcome measures included patient utilization and perception. Balancing measures included hypoglycemic events. Data were reviewed through iterative Plan-Do-Study-Act (PDSA) cycles to refine both KAP content and implementation workflow. Results: Factors limiting ketone self-management identified by root cause analysis included clinic culture, 24/7 call line access, variability among provider recommendations, variability among societal guidelines, and fear among patients, caregivers and providers. While 860 patients received KAPs, only 47% of KAPs were documented in the EHR. Following implementation, ketone-related emergency calls decreased by 7%. Families (n=24) reported high comfort and ease of use (mean 1.2 and 1.1 on 5-point Likert scale). One hypoglycemic event was reported among KAP users. Providers (n=30) felt comfortable implementing KAPs but reported challenges with time, comprehension for those with low health literacy, and variations in ketone dose suggestions. Conclusion: Individualized KAPs fostered patient confidence and reduced call volume without increasing adverse events. However, provider non-documentation and workflow challenges limit scalability. Future PDSA cycles will target EHR integration, provider time constraints, and explore expansion to schools. Disclosure J.T. Hooven-Davis: None. A. Miyagusuku Chang: None. L.M. Cervenak: Other - Certified pump trainer-independently contracted; Current; Tandem Diabetes Care, Inc. K.M. Fantaskey: Employee; Current; Insulet Corporation. A. Gilliland: None. R. Grecek: None. O. Krolczyk: Stock/Shareholder; Current; Dexcom, Inc., Medtronic. Consultant; Current; Tandem Diabetes Care, Inc. Stock/Shareholder; Current; Tandem Diabetes Care, Inc.