Diabetes patients develop preventable complications in hospital and access to specialist staff is 'inadequate'

Clinical audit shows patient care improving, but there is 'a great deal more to do'

June 26, 2014: Over a fifth (22.0 per cent) of patients with diabetes in hospital will have experienced a largely avoidable hypoglycaemic episode⁶ in hospital within the past seven days, according to a national audit report released today.

One in ten (9.3 per cent) will have experienced a severe hypoglycaemic episode and one in 50 (2.2 per cent) required injectable treatment due to the severity of the hypoglycaemia.

This is despite the fact that only 8.1 per cent of respondents had been admitted for their diabetes or a diabetic complication.

The findings are published today in the National Diabetes Inpatient Audit (NaDIA), carried out by the Health and Social Care Information Centre, in collaboration with Diabetes UK. NaDIA is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme³

The report found that over a third of inpatients (37.5 per cent) who should have been referred to a hospital diabetes team did not see a diabetes specialist⁸; almost one third (31.7 per cent) of sites in the audit had no diabetes inpatient specialist nurses (DISNs); and over one in 20 (5.3 per cent) had no consultant time for diabetic inpatient care. Almost three quarters (71.2 per cent) of sites had no specialist inpatient dietetic staff time for people with diabetes.

This is despite the report's findings that almost one in six people in a hospital bed has diabetes and that the percentage of hospital beds occupied by people with diabetes has risen each year (from 14.6 per cent in 2010 to 15.8 per cent in 2013).

The report also found that the more than a third of patients (37.0 per cent) with diabetes experienced a medication error⁹, down from 39.9 per cent in 2011. Patients who had experienced a medication error were more than twice as likely to suffer a severe hypoglycaemic episode (15.3 per cent) compared to those with no error in their medication (6.8 per cent).

The National Inpatient Diabetes Audit (NaDIA) examines data about inpatients with diabetes collected by hospital teams in England and Wales on a nominated day in a defined week in September. It covers issues such as staffing levels, medication errors, patient harm and patient experience. The 2013 audit involved 14,198 patients with diabetes in 142 trusts in England and six local health boards in Wales.

The data also shows:

Diabetic Ketoacidosis

• 63 patients (0.4 per cent) were reported to have developed diabetic ketoacidosis (DKA) after their admission. This is a life threatening but preventable complication, resulting from a severe shortage of insulin.

Podiatry

• All patients with diabetes should have a foot examination on admission, to detect and prevent foot complications. There happened in 42.4 per cent of cases in 2013, a significant increase from 25.8 per cent in 2011.
• 9.2 per cent of patients were admitted with active diabetic foot disease¹⁰, all of whom should be seen by the multidisciplinary foot care team within 24 hours of admission. Of these, 61.1 per cent were seen by a member of the team within 24 hours, and 69.3 per cent had seen a member of the team within the past seven days.
• The proportion of patients developing a foot lesion in hospital has reduced from 2.2 per cent in 2010 to 1.4 per cent in 2013.

Patient satisfaction with timing and content of meals

• 14.7 per cent of patients reported that the hospital did not provide the right kind of food to manage their diabetes.
• 15.1 per cent of patients said that they needed food to be brought into hospital to meet their dietary requirements and/or manage their diabetes.

Audit lead clinician Dr Gerry Rayman said: "The purpose of this annual clinical audit is to drive improvements in care for inpatients with diabetes. We are therefore delighted to see year on year improvements including reductions in patient harm. This is good news but there is still a great deal more to do.

"Whilst it is welcome to see that the percentage of patients experiencing hypoglycaemia in hospital fell from 25.7 per cent in 2011 to 22.0 per cent in 2013, the number of patients developing this largely preventable complication remains unacceptably high. Additionally, although a 36 per cent reduction in hospital acquired foot ulceration from 2.2 per cent to 1.4 per cent is very impressive, the frequency of this wholly preventable complication remains significantly greater than in those without diabetes.

"The role of specialist diabetes staff within hospitals is crucial; it is therefore disappointing that staffing levels remain inadequate and it is unacceptable that over 30 per cent of trusts continue to have no diabetes inpatient specialist nurses.

"Diabetes is dependent on the whole of the hospital team working together to deliver safe care: from specialists, to junior medical staff, non-specialist nursing staff, health care assistants, dieticians, podiatrists, pharmacists and even catering staff.

"Were every trust in England and Wales to invest in a fully staffed inpatient diabetes team, many expensive and avoidable complications could be prevented with considerable savings in bed days. More importantly, there would be a significant improvement in patient satisfaction, and a reduction in morbidity and mortality."

http://www.hscic.gov.uk/

Having read of fellow diabetics experiences when hospitalised I'm not at all surprised by this article.

Graham