Abolishing Routine RBS and Encouraging Routine HgbA1C in our Diabetic Clinic: A Quality Improvement Project.

Kijabe Hospital staff wanted to do a better job of caring for their patients with diabetes. They joined a quality improvement collaborative with other mission hospitals to learn the science and methodology of quality improvement. They were concerned about the  wasted cost and time consumption associated with routine RBS, which is done on all patients in the DM clinic, while over a quarter of the patients do not have up-to-date HgbA1C. The lack of updated A1C levels can result in unknown control of diabetic patients.

The project aims to stop routine RBS and increase routine HgbA1C to 100% by 10th March 2023. The team’s SMART goal is to ensure that management of DM is guided by A1C at appropriate intervals to assess control of their diabetes and adjust treatment accordingly.

The project team reviewed the Daily diabetes register for October and November 2022 and found that RBS is done for 100% of their patients, yet 26.5% of patients do not have up-to-date A1C, which is the preferred test.

The project team implemented interventions to tackle the key drivers of the problem, which included continuing medical education for staff and sensitizing patients on the importance of hemagloblin A1C (HgA1C) over (random blood sugar) RBS in diabetes management. The interventions also involved escalating concerns to the director of laboratory services so that  management monitor  quality controls in lab for HgA1C accuracy

And they got results! Wasteful use of routine blood sugar testing dropped by 80% and proper use of HgA1C increased dramatically! The Kijabe team saw their dream of better and more cost effective care for their diabetic patients become a reality.

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