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Inpatient audit reveals no DSNs in quarter of hospitals

By Editor
14th March 2018
Audits, Care planning Inpatient

More than a quarter of hospital sites do not have dedicated diabetes inpatient specialist nurses, according to the 2017 National Diabetes Inpatient Audit (NaDIA).

The audit was introduced in 2010 to measure the quality of diabetes care provided to people with either type 1 or type 2 while they are admitted to hospital, whatever the cause, and aims to support quality improvement.

The most recent figures have also revealed that despite important improvements, almost a third of people in hospital (31 per cent) with diabetes experienced a medication error, and around one in five (18 per cent) had a hypo during their hospital stay.

No improvement has been made in the number of inpatients with type 1 diabetes who are affected by diabetic ketoacidosis (DKA), with data showing one in 25 people admitted to hospital (4 per cent) have developed DKA during their stay.

Analysts said although there has been an improvement in the proportion of people with diabetes being seen by a specialist diabetes team where appropriate, 28 per cent of people still did not receive this.

Dr Gerry Rayman, the national clinical lead for Inpatient Diabetes, said: “Diabetes teams are doing fantastic work to improve diabetes care, as evidenced by the audit. Since 2010 there has been a 30 per cent reduction in severe hypoglycaemic rates, a 40 per cent reduction in foot pressure ulcers occurring in hospital and reduction in all medication errors.

“Whilst the improvements are notable there is still a large variation in care across England and Wales and harm arising from DKA due to insulin mismanagement remains a worrying problem. Thus, there is still a lot more work to do be done across England and Wales, if people with diabetes are to receive first class care and have confidence in their healthcare teams.”

It is thought there are now around one in six (18 per cent) hospital beds in England and Wales occupied by someone with diabetes, and this is set to increase. Diabetes UK said this is putting “notable pressure on staff and hospitals”.

The charity also stated how important it is that diabetes is made a priority for all hospital trusts and staff receive all the relevant training needed to support this increasing number of patients. It is calling for the NHS England Transformation Funding to continue funding diabetes specialist inpatient nurses in hospitals beyond April 2019.

David Jones, assistant director of improvement support and innovation at Diabetes UK, said: “It is essential that people with diabetes feel safe when they stay in hospital. We have spoken to too many people who don’t, and these figures show that there is still work to do to improve safety. We need to do more to support diabetes teams to help their colleagues provide safe and appropriate care.”

The results of the audit were unveiled at the Diabetes UK Professional Conference (DUK), currently taking place in London. Data is collected and submitted by hospital staff in England and Wales. NaDIA is part of the National Diabetes Audit (NDA) portfolio within the National Clinical Audit and Patient Outcomes Programme (NCAPOP), commissioned by the Healthcare Quality Improvement Partnership (HQIP).

Overall, the data has shown that since NaDIA was launched, there have been very impressive improvements in many aspects of inpatient diabetes care, including reductions in medication errors, severe hypoglycaemia and hospital- acquired diabetic foot lesions.

Key findings
Bedside data on 16,010 inpatients was submitted, 200 more than NaDIA 2016
Around 1 in 6 hospital beds are occupied by a person with diabetes (18 per cent). 1 in 15 of the total population have diabetes (7 per cent)
More than a quarter of hospital sites report no dedicated diabetes inpatient specialist nurses (DISNs) (28 per cent)
One fifth of hospital sites do not have a multi-disciplinary footcare team (MDFT) (20 per cent), though this proportion has reduced from 42 per cent in 2011
Almost one third of inpatients with diabetes have a medication error during their hospital stay (31 per cent)

To read the report, click here.

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