The prevalence of all hypoglycaemic episodes in hospital, both mild and severe, has decreased from 26% in 2011 to 20% in 2016. Rates of mild hypoglycaemia fell to 18%, while severe hypo rates fell to 8%. The rate of the most severe, life-threatening hypoglycaemia also fell from 2.2% in 2011 to 1.7% in 2016.
Other improvements in care identified in the report include a reduction in the proportion of people receiving intravenous insulin infusions (from 11% to 8%), and of people receiving excessively long insulin infusions (8% to 6%). In addition, the proportion of inpatients who develop a diabetic foot lesion during their stay fell from 2.2% to 1.3%.
Less positive developments include the 28% of hospitals that had no specialist nurses to support inpatients with diabetes, despite the record high rates of beds being occupied by people with diabetes (up two percentage points at 17%). Rates of diabetic ketoacidosis (4%), hyperosmolar hyperglycaemic state (0.2%) and medication errors on drug charts (38%) have all remained more or less static.
Commenting on the findings, the audit’s lead clinician, Gerry Rayman, said:
“We have seen a number of successes which include falls in the instances of hypoglycaemic episodes, unnecessary insulin infusions and hospital-acquired foot ulcers. These are, in part, due to the take up of new and more efficient ways of working. The number of hospital sites with care improvement initiatives such as Electronic Patient Records and Electronic Prescribing has increased since 2013, and diabetes Mortality and Morbidity meetings are now held in 53 per cent of sites.
“Each year, we have seen inpatient numbers increasing steadily and, today, around a third of inpatients in a few hospitals have diabetes. There has been little change in staffing levels to accommodate this rise and while overall satisfaction with care is high, the audit shows that there is more work to be done. The audit is stimulating people to ask questions about their hospital care which will also help to drive forward improvements.
“Improvements in medicine management, identifying those at risk, educating other health care professionals and implementing best practice will be a focus for specialist teams within hospitals who are committed to delivering an excellent service to patients with diabetes, despite the many demands upon them.”
“While we can celebrate the achievements of the NaDIA, we must continue to focus on reducing preventable and serious complications including severe hypoglycaemia, hospital acquired foot ulceration, diabetic ketoacidosis and hyperosmolar hyperglycaemic state.”
The report can be read in full at: http://www.content.digital.nhs.uk/catalogue/PUB23539
