Implementing point of care blood ketone testing in the Emergency Department

Kinsella, JM; Barker, G; King, J; Webber, MGT; Boyd, M; Ho, KWK; Gallagher, R

Implementing point of care blood ketone testing in the Emergency Department

Kinsella, JM Barker, G King, J Webber, MGT Boyd, M Ho, KWK Gallagher, R

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Publication Type:: Journal Article
Citation:: Australasian Emergency Nursing Journal, 2012, 15 (2), pp. 63 - 67
Issue Date:: 2012-05-01

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Field	Value	Language
dc.contributor.author	Kinsella, JM	en_US
dc.contributor.author	Barker, G	en_US
dc.contributor.author	King, J	en_US
dc.contributor.author	Webber, MGT	en_US
dc.contributor.author	Boyd, M	en_US
dc.contributor.author	Ho, KWK	en_US
dc.contributor.author	Gallagher, R https://orcid.org/0000-0001-5588-9351	en_US
dc.date.issued	2012-05-01	en_US
dc.identifier.citation	Australasian Emergency Nursing Journal, 2012, 15 (2), pp. 63 - 67	en_US
dc.identifier.issn	1574-6267	en_US
dc.identifier.uri	http://hdl.handle.net/10453/22519
dc.description.abstract	Background: Rapid and accurate testing of blood ketone levels (BKL) can assist in the assessment of insulin insufficiency and detection of diabetic ketoacidosis (DKA) in the acute care setting. We assessed the potential for introducing point of care measurement of BKL into an Australian emergency department. Methods: After providing informed consent, 72 patients (80 separate presentations) with insulin-requiring diabetes who presented to an emergency department with hyperglycaemia (capillary blood glucose level of ≥10.0. mmol/L) underwent testing for BKL at triage. Staff were guided by a protocol developed for interpretation of elevated BKL ≥ 1.0. mmol/L and subsequent actions. Urine ketones and arterial blood gas testing occurred as usual. Time to testing was recorded for all measures. Results: BKL testing occurred immediately in 91% of the presentations, whereas urine ketones and arterial blood gas testing was uncommon (24% and 15% respectively) and not immediate. Elevated BKL (≥1.0. mmol/L) occurred in 17% of presentations, of whom five were diagnosed with DKA within the Emergency Department. However, testing for BKL decreased over the duration of the study. Patients most frequently tested for BKL were younger (58.59 years) than patients who were not tested (79.5 years) (p= .011). Conclusions: Implementation of point of care BKL testing in the Emergency Department can assist in the detection of significant numbers of patients with insulin insufficiency, however, ongoing education and support is required to sustain the change in practice. © 2012.	en_US
dc.relation.ispartof	Australasian Emergency Nursing Journal	en_US
dc.relation.isbasedon	10.1016/j.aenj.2012.04.002	en_US
dc.subject.classification	Nursing	en_US
dc.title	Implementing point of care blood ketone testing in the Emergency Department	en_US
dc.type	Journal Article
utslib.citation.volume	2	en_US
utslib.citation.volume	15	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	2	en_US
pubs.publication-status	Published	en_US
pubs.volume	15	en_US

Abstract:

Background: Rapid and accurate testing of blood ketone levels (BKL) can assist in the assessment of insulin insufficiency and detection of diabetic ketoacidosis (DKA) in the acute care setting. We assessed the potential for introducing point of care measurement of BKL into an Australian emergency department. Methods: After providing informed consent, 72 patients (80 separate presentations) with insulin-requiring diabetes who presented to an emergency department with hyperglycaemia (capillary blood glucose level of ≥10.0. mmol/L) underwent testing for BKL at triage. Staff were guided by a protocol developed for interpretation of elevated BKL ≥ 1.0. mmol/L and subsequent actions. Urine ketones and arterial blood gas testing occurred as usual. Time to testing was recorded for all measures. Results: BKL testing occurred immediately in 91% of the presentations, whereas urine ketones and arterial blood gas testing was uncommon (24% and 15% respectively) and not immediate. Elevated BKL (≥1.0. mmol/L) occurred in 17% of presentations, of whom five were diagnosed with DKA within the Emergency Department. However, testing for BKL decreased over the duration of the study. Patients most frequently tested for BKL were younger (58.59 years) than patients who were not tested (79.5 years) (p= .011). Conclusions: Implementation of point of care BKL testing in the Emergency Department can assist in the detection of significant numbers of patients with insulin insufficiency, however, ongoing education and support is required to sustain the change in practice. © 2012.

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http://hdl.handle.net/10453/22519