Optimising the measurement of blood glucose and cholesterol in patients who had an acute stroke: a quality improvement project

Abstract

Hypercholesterolaemia and diabetes are established modifiable risk factors for cerebrovascular disease. A baseline audit carried out on an acute stroke ward at a District General Hospital in East Kent showed variability in blood tests being requested on admission for patients who had a suspected stroke, in particular serum glucose and cholesterol levels. Our aim was to ensure that at least 80% of patients admitted to the stroke ward with a suspected stroke had blood glucose and cholesterol levels measured on admission, over an 18-week period.The percentage of patients admitted with a suspected stroke on the ward who had the appropriate investigations requested on admission was measured weekly. Quality improvement methodology was used to formulate three interventions in the form of Plan-Do-Study-Act cycles: (1) an educational email sent to doctors regarding the assessment of patients who had a stroke and admission blood tests required; (2) adaptation of the ‘Stroke Admission Clerking Proforma’ to include a list of bloods to be requested; (3) production of an all-inclusive ‘Stroke Bloods Panel’ on the online system for requesting bloods.At baseline, an average of 30% and 34% of patients had glucose and cholesterol levels requested on admission, respectively. These results increased to 43% and 40% after the first intervention; 71% and 61% after the second intervention; and after the final intervention, on average, 82% and 85% of patients had glucose and cholesterol levels requested, respectively. We therefore achieved our aim of ensuring that more than 80% of patients who had an acute stroke had the appropriate blood tests requested on admission.The modified stroke proforma and the blood panel were the most effective interventions. The changes were implemented in an additional hospital within the same Trust. We anticipate greater compliance with Royal College of Physicians (RCP), National Institute for Health & Care Excellence (NICE) and Trust guidelines regarding appropriate and timely prescription of antidiabetic and cholesterol-lowering medications for secondary preventative measures.