PERFORMANCE IMPROVEMENT PROJECT : GLYCEMIC CONTROL OF INPATIENTS

S.NO Treating Age Sex Nationality Date of Blood Sugar LEVELS Treatment Plan Education to Diabetic Date of
Consultant Admission On Admission Patients Discharge
FBS On FBS After HbA1c S/Scale Insulin Oral Upon During Upon
Admission 48 Hours Admission Stay Discharge

Date: ______________ Department:______________ Head Nurse In Charge:_________________

(This Survey form should be submitted to Quality Department in the FIRST WEEK of every Gregorian Month)