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PP30 Exploring ambulance and emergency department clinician experiences of capillary blood ketone meter use in the ambulance setting: semi-structured interviews
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  1. Larissa Prothero1,
  2. Thomas Strudwick1,
  3. Theresa Foster1,
  4. Ketan Dhatariya2,6,
  5. Adrian Boyle3,
  6. Andrea Lake3,
  7. Julia Williams4,
  8. Gerry Rayman5,6
  1. 1East of England Ambulance Service NHS Trust, Barton Mills, UK
  2. 2Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
  3. 3Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  4. 4University of Hertfordshire, Hatfield, UK
  5. 5East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
  6. 6University of East Anglia, Norwich, UK

Abstract

Background KARMA2 was a feasibility study which explored whether ambulance clinicians could reliably and safely identify diabetic ketoacidosis (DKA) using capillary blood ketone meters and commence fluid therapy (0.9% saline) in accordance with the study protocol, to determine if a large-scale clinical trial was warranted. One aim of this study was to understand the experiences of ambulance and hospital clinicians regarding ambulance hyperglycaemia care and impacts of blood ketone meter use.

Methods During May to September 2022, twenty online, semi-structured qualitative interviews were carried out with emergency care staff involved with the KARMA2 study: a convenience sample was obtained comprising 10 ambulance paramedic and non-paramedic participants and 10 Emergency Department (ED) doctors and nursing staff employed at study partner hospitals. Following transcription, interviews were analysed using an inductive thematic approach.

Results Ambulance staff reported positive experiences using capillary blood ketone meters and considered them a beneficial diagnostic tool for DKA recognition, commencement of fluid therapy for ‘high-risk DKA’, improved clinical handovers and safety-netting. There appears to be scope for improved ambulance hyperglycaemia education - ‘sick day rules’ and euglycaemic DKA were unfamiliar for most. ED staff were supportive of ambulance blood ketone assessments and ‘high-risk DKA’ pre-alerts. They considered them to expedite hospital DKA diagnosis and prioritise resuscitation bed allocation and care. Additionally, pre-hospital cannulation and fluid therapy would facilitate prompt initiation of hospital DKA management protocols. Meter use would also support differentiation of DKA from other hyperglycaemic emergencies, i.e., hyperosmolar hyperglycaemic state.

Conclusion Ambulance capillary blood ketone meter use offers earlier recognition of patients at high risk of DKA, the opportunity to commence fluid therapy prior to hospital arrival, and prioritise ongoing care. Full KARMA2 data analysis is ongoing; however, study findings are informing a content update to the current Joint Royal Colleges Ambulance Liaison Committee Glycaemic Emergencies clinical guidelines.

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