Deficits in staffing levels are a clear problem identified in the report. The number of inpatient referrals requiring the inpatient diabetes team has increased; however, there has been no corresponding increase in staffing levels and only two thirds of inpatients requiring referrals were seen. Almost one third of sites surveyed in the audit have no diabetes inpatient specialist nurse available, with no increase since the audit’s inception 5 years ago, and the number of hospital sites with no specialist dietitian has also increased. Furthermore, 31% of sites have no multidisciplinary diabetic foot care team (MDT). While this gap in healthcare provision has shrunk since 2010, the trend in improvement has reversed since the last audit in 2013.
Perhaps partly because of this, two thirds of inpatients did not undergo a specific diabetic foot risk examination, and two fifths of those who were admitted with pre-existing foot disease were not seen within the first 24 hours by the foot MDT.
Since NaDIA began, there have been important improvements in medication errors and, particularly, insulin prescription errors. There has also been a very significant reduction in the use of insulin infusions. This is welcome; however, blood glucose control whilst on infusions remains unsatisfactory. The proportion of inpatients experiencing medication errors has increased since the previous audit, reversing the earlier trend. Furthermore, the rate of inappropriate insulin infusions has not significantly decreased in the last 2 years, and there has been no change in rates of severe hypoglycaemia or diabetic ketoacidosis (DKA) occurring in hospital over the whole audit period.
Finally, inpatient satisfaction has reduced since the previous audit, with 34% of patients reporting that the hospital sometimes, rarely or never provided the right choice of food to manage their diabetes.
Gerry Rayman, Clinical Lead for NaDIA, thanked the diabetes teams both for their hard work in carrying out these annual audits but also for their dedication to improve inpatient care. He added: “They should feel pleased to know that their efforts have resulted in improvements in all areas of care since the first NaDIA but will be disappointed to know that this still does not extend to staffing levels. Greater investment into inpatient diabetes teams is needed to accelerate these improvements; this would be rewarded by better patient experience, reduced harm, reduced length of stay and reduced costs to the NHS. A worthwhile investment!”
The report can be read in full at: http://www.hscic.gov.uk/catalogue/PUB20206
