Concerns Raised Over Hospital Safety for Diabetes Patients

Peter Russell

October 08, 2018

Urgent measures are needed to make hospitals safer for inpatients with diabetes, a report has concluded after it highlighted "concerning inadequacies" in care.

An analysis by Diabetes UK found that in 2017, 260,000 people with diabetes experienced a medication error in hospital that could have resulted in serious harm or even death, and 58,000 had an episode of severe hypoglycaemia because of poor insulin management.

It called for hospitals to adopt six strategies to make them safer for people with diabetes, shorten lengths of stay and lead to improved patient experience.

Over a million people with diabetes were admitted to hospital in England in 2017, although 92% were not admitted because of their diabetes. Currently 1 in 6 hospital beds is occupied by someone who has diabetes, and by 2030 it is predicted this will have risen to 1 in 4.

The report, Making Hospitals Safe for People with Diabetes , said people with diabetes have high infection rates, lengths of stay between 1 and 3 more days than those without diabetes, and a 6.4% higher rate of mortality.

It highlights recent diabetes audits that have shown that while some hospitals have made year-on-year improvements in diabetes care, others have fallen behind.

Emily Watts from Diabetes UK, who co-authored the report, said: "We want hospitals to stop working alone, and start learning from each other's successes."

The six recommendations in the analysis were:

Resourced Multidisciplinary Diabetes Inpatient Teams

The report found that hospitals were struggling to recruit into specialist posts, while the number of trainee doctors choosing to specialise in diabetes was in decline.

It identified a quarter of sites that were lacking a diabetes inpatient specialist nurse.

With inpatient care for diabetes costing the NHS £2.5 billion each year (11% of the total inpatient budget), significant savings could be made by having fully resourced and qualified teams available 7 days a week, the report argued.
 

Strong Clinical Leadership

Successful leaders from diabetes inpatient teams should be able to champion care and ensure diabetes is on the agenda for NHS trusts, the report said.

Teams should host quarterly diabetes and insulin safety meetings to discuss incident reports and strategy. 
 

Understanding Diabetes

Trainee doctors have reported lacking confidence in managing diabetes and a reluctance to take the initiative to optimise glycaemic control, according to the analysis. It said patients and frontline staff have raised this issue as "a major concern".

Ward pressure, a high staff turnover, and reliance on agency staff were cited as contributing to the problem.

The report called for hospital support for healthcare professionals to be trained in the safe use of insulin, and training for undergraduate doctors and trainee nurses in the basics of inpatient diabetes care.

Supporting Patients to Take Care of Their Diabetes

The report highlighted results of a survey of people with diabetes who felt that hospital meal choices, meal timing, and staff awareness of diabetes had deteriorated since 2011.

Patients also expressed concerns that they would not be able to manage their own condition during their stay by, for instance, having their insulin taken away from them on admission.

The report called for patients with diabetes to have a care plan put in place and for greater attention to meals and meal times so that people know what to expect in hospital and feel able to ask for what they need.

Better Access to Systems and Technology

The report called for diabetes inpatient teams to have the resources available to identify people with diabetes when they are admitted to hospital.

It highlighted the example of York Hospital, which was able to identify all people with diabetes on admission through links with its retinal screening service.

It said an effective screening service minimised the chances of health problems at a later stage.

Hospitals should also have an electronic safe discharge checklist to reduce the chance of future admission.
 

Helping Learn from Mistakes

Figures have shown that in 2017, one in 25 people with type 1 diabetes experienced hospital-induced diabetic ketoacidosis as a result of under treatment with insulin.

The report underlined the importance of cultivating an environment where errors are reported and action taken so that they are not repeated.

Methods should be in place to ensure data collection is robust and the data is subjected to rigorous analysis, it said.

Chris Askew, chief executive of Diabetes UK, said: "The NHS is under immense strain, and diabetes is just one of the complex issues competing to be a priority. However, the number of diabetes inpatients receiving inadequate levels of care is a clear reflection that more must be done to make hospitals safe for those living with diabetes.
 
"The evidence clearly shows that fully resourced, proactive diabetes inpatient teams and an educated inpatient workforce can lead to happier, better supported patients and shorter lengths of stay. We will continue to work for better care for people with diabetes until every patient feels safe in hospital, from the time of admission to the point of discharge."
 

Response by the NHS

A spokesperson for NHS England said: "NHS England has recently invested £10 million to increase the number of specialist diabetes nurses working in hospitals and evidence shows they help reduce lengths of stay and medication errors for patients with diabetes.

"As we draw up the long term plan for the NHS, we need to build on existing work, including the Diabetes Treatment and Care programme, to help tackle this growing problem."

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