Nurses working to top of scope of practice can reduce clinical workload in metabolic services

Abstract

Background: Since the introduction of a Nurse Practitioner (NP) role in the Queensland Metabolic Medicine Service, the number of emergency department (ED) consults and re-presentations for children with hypoglycemia has significantly declined. Methods: A retrospective chart audit revealed that in the year of 2017, 53 children presentedwith hypoglycemia associated with an inter-current illness that affected appetite. Most children fasted the equivalent of more than 30 hours without a solid source of carbohydrate. Results: Fifteen percent re-presented to the ED with 1 patient representing twice prior to attending the NP clinic with zero re-presentations after attending the NP clinic. Discussion: A hospital-wide policy was created outlining appropriate investigations at time of hypoglycemia, management in the acute setting and if required, admission under the general pediatric team with a post discharge referral to the NP clinic. The NP clinic included review of the hypoglycemia screen to exclude the known endocrine andmetabolic causes of hypoglycemia in this age group, leaving a likely diagnosis of ketotic hypoglycemia of childhood; pathophysiology of glucosemetabolism, age appropriate carbohydrate sick day fluid plan with recipes; instructions when to seek medical review. Conclusion: Parents/carers respond to education outside of the critical time of illness. Education regarding sick day management can reduce the high dependence on subspecialty services which allows clinician time to be allocated toward acutely presenting metabolic disorders.L6298897602019-11-22 <br />