P-301: A quality improvement project on the management of paediatric diabetic ketoacidosis
J Kumar, A Shetty, A OwensAbstract
Introduction
Diabetic ketoacidosis is a common and life-threatening acute complication of diabetes in children. Optimal management requires timely administration of therapeutics in accordance with local and national guidelines. However, variation in clinical practice and delays in treatment may impact patient outcomes. This project is aimed to evaluate the quality of care in the management of paediatric DKA in the Cardiff and Vale Health board
Objectives
To analyse paediatric DKA cases in South Wales between March 2024 and January 2026 to identify trends across audit cycles. Identify drivers of suboptimal care in the system and management guidelines
Methods
A retrospective case note analysis of paediatric patients diagnosed with DKA at the Children’s Hospital for Wales between March 2024 and January 2026 was performed. Patient notes were audited against DKA pathway adherence within the integrated care pathway
Results
31 patients were identified to be diagnosed with DKA in the study period, of which 19 patients records were available for analysis. Commencement of initial fluid bolus ranged from 10 to 85 minutes with a mean of 29.4 minutes. Commencement of maintenance fluids after the initial bolus was completed ranged from 15 to 135 minutes with a mean of 61.9. Time until pH normalisation ranged from 0-51 hours with a mean of 17.9. Insulin start times ranged from 0.5 to 5 hours with a mean of 2.3. 21% of patients had good adherence to insulin start times, 32% were within the appropriate range, 47% fell outside the target window
Conclusions
This quality improvement project demonstrates variability in management, with almost a majority (47%) of treatment falling outside target times. Correlation analysis between fluid initiation and pH normalisation shows no clear relationship, although visual trends suggest faster recovery. Discrepensies may be due to DKA severity and other clinical factors. Further audit cycles with larger stratified samples are needed to better asses the relationship between treatment timing and outcomes.