How to mitigate risk for a patient with hypoglycemia and eating disorder, history of falls due to dizziness, who needs to take out their service dog alone, with no staff available for supervision?

From the Guidelines

To mitigate risk for this patient with hypoglycemia and an eating disorder who needs to take his service dog out alone, I strongly recommend implementing several safety measures before he leaves the ward, prioritizing his immediate hypoglycemia risk and fall risk, as outlined in the most recent guidelines from 2023 1.

Key Safety Measures

• Ensure the patient checks his blood glucose level and has a snack or glucose tablets (approximately 15-20 g) immediately before going out, as recommended for treating hypoglycemia 1.
• Provide him with a portable glucose monitor and extra glucose tablets or a fast-acting carbohydrate source to carry with him, in line with recommendations for managing hypoglycemia 1.
• The patient should wear a medical alert bracelet identifying his hypoglycemia risk and carry a fully charged cell phone programmed with emergency contacts.
• Set a specific time limit for the outing (15-20 minutes) with clear instructions to return if he feels dizzy or experiences any hypoglycemic symptoms, considering his history of falls from dizziness.
• Consider providing a walker or other stability aid if appropriate for his fall risk, given the potential for hypoglycemia to exacerbate this risk.
• Have the patient agree to a "buddy check" system where he calls or texts a designated staff member upon returning, to ensure his safety and prompt intervention if needed.

Rationale

These measures are based on the latest guidelines for managing hypoglycemia, which emphasize the importance of prompt treatment and prevention of recurrence 1. By providing the patient with the means to monitor and treat his blood glucose levels, and by setting clear boundaries and communication protocols, we can minimize the risk of serious adverse events while still respecting the patient's autonomy and need to care for his service animal. The recommendations from the 2023 guidelines 1 take precedence due to their recency and high quality, providing the most up-to-date approach to managing hypoglycemia and mitigating its risks.

From the Research

Mitigating Risk for a Patient with Hypoglycemia and Eating Disorder

To mitigate the risk for a patient with hypoglycemia and an eating disorder who needs to take out their service dog by themselves, especially with a history of falls from dizziness and hypoglycemia, and without staff available to supervise, consider the following steps:

• Assess the Patient's Current Condition: Before the patient goes off the ward, assess their current blood glucose level to ensure it is within a safe range 2. This is crucial as hypoglycemia can impair the patient's ability to safely care for themselves and their service dog.
• Provide Easy Access to Glucose: Ensure the patient has easy access to a quick-acting glucose source, such as glucose tablets or juice, in case their blood glucose levels drop while they are out 3. Educate them on how to administer these to themselves if needed.
• Use of Continuous Glucose Monitoring (CGM): Consider the use of CGM for patients with increased risk for hypoglycemia, as it can provide real-time data on glucose levels, helping to prevent severe hypoglycemic episodes 4.
• Education on Hypoglycemia Prevention and Management: Educate the patient on the signs and symptoms of hypoglycemia, how to prevent it, and how to manage it if it occurs 2, 4. This includes understanding the importance of regular meals, the role of physical activity, and how to adjust insulin doses or carbohydrate intake accordingly.
• Service Dog Training: If the service dog is trained to assist the patient during hypoglycemic episodes, ensure the dog is with the patient at all times when they are off the ward. The dog can be trained to fetch help or provide physical support if the patient becomes dizzy or disoriented.
• Communication Device: Consider providing the patient with a communication device, such as a phone or a wearable alert system, that they can use to call for help if they experience any symptoms of hypoglycemia or if they fall 5.
• Ward Environment Adjustment: Before the patient leaves the ward, ensure that the path they will take is clear of obstacles to reduce the risk of falls. Also, inform other hospital staff in the area that the patient will be walking their service dog, so they can provide assistance if needed.
• Regular Check-ins: Establish a system for regular check-ins with the patient after they have taken their service dog out, to ensure they are safe and their blood glucose levels are stable.

Legal and Ethical Considerations

When balancing the patient's autonomy with the need to ensure their safety, consider the ethical and legal implications of restricting or liberalizing patient movement within the hospital 5. Developing clear policies that respect patient autonomy while ensuring safety can help guide decision-making in such situations.