Nearly one in three hospital patients with diabetes are affected by errors which can result in dangerously high or low blood glucose levels, according to a national audit report released today.
In England and Wales, 3,700 inpatients with diabetes experienced at least one error in their treatment in hospital in one week, according to the National Diabetes Inpatient Audit (NaDIA).
The audit is managed by the Health and Social Care Information Centre in partnership with Diabetes UK and commissioned by the Healthcare Quality Improvement Partnership.
Complications experienced by inpatients
During the seven-day audit period, the patients with errors suffered more than double the number of severe hypoglycaemic – 'hypo' – episodes compared to patients without errors.
In addition, 68 patients developed diabetic ketoacidosis (DKA) during their stay in hospital. DKA, which can be fatal if not treated, occurs when blood glucose levels are consistently high – which suggests that insulin treatment was not administered for a significant period of time.
The audit examined bedside data for 12,800 patients and 6,600 patient questionnaires, covering subjects including medication errors and patient harm during a week in October 2011. It involved 11,900 patients in 212 English hospitals and 900 patients in 18 Welsh hospitals.
The data shows that during the seven days:
- The percentage of patients who experienced at least one medication error in the previous seven days of their hospital stay was 32.4 per cent in England and 29.8 per cent in Wales.
Medication errors were recorded under two types: 'prescription error' or 'medication management error', and some patients experienced both types while in hospital.
- 20.7 per cent of patients with diabetes in England, and 16.6 per cent in Wales, experienced a prescription error.
- Of those patients, the most common error was failing to sign off on the patient’s bedside information chart that insulin had been given, which happened to 11.1 per cent of patients in England and 9.4 per cent in Wales.
Medication management errors
- 18.4 per cent of patients with diabetes in England, and 17.8 per cent in Wales, experienced medication management errors.
- Of those patients, the most common error was failing to appropriately adjust medication when they had a high blood sugar level, which happened to 23.9 per cent in England and 24.8 per cent in Wales.
- In England, 17.4 per cent of patients with medication errors had a severe hypoglycaemic attack while in hospital, compared to 7.5 per cent of patients without medication errors. In Wales, 17.2 per cent of patients with medication errors had a severe hypoglycaemic attack while in hospital, compared to 8.4 per cent of patients without medication errors.
68 patients (0.6 per cent) developed DKA while in hospital in England. Three patients (0.3 per cent) developed DKA while in hospital in Wales.
Inadequate care "unacceptable"
Barbara Young, Chief Executive of Diabetes UK, said: “It is unacceptable for any person in hospital to receive inadequate care and yet this report shows that almost one in three people with diabetes in hospital experiences an error in their treatment. The fact that there are so many mistakes and that for some people a stay in hospital means they get worse should simply not be happening.
"Severe and dangerous consequences"
“Poor blood glucose management, caused by errors in hospital treatment, is leading to severe and dangerous consequences for too many people. For example, there are a number of recorded episodes of diabetic ketoacidosis (DKA), the result of extremely high blood glucose levels caused by a lack of insulin. This is an indictment of how hospitals are failing to care for people with diabetes.
"Urgent action needed"
“Although we know that some excellent steps have been taken, including courses and online tools, to increase knowledge and education amongst health care staff for the treatment of people with diabetes on hospital wards, we are not seeing good enough results from this yet. The fact that the situation has barely improved in the last year shows that the NHS is not yet taking this seriously enough.
“Urgent action is needed to make sure that general ward staff are competent and confident about treating inpatients with diabetes. Also, we believe that every hospital should have a specialist diabetes inpatient team for inpatients. If every diabetes inpatient was seen daily by a relevant specialist such as a Diabetes Specialist Nurse (DSN), their care could be greatly improved.”
"A long way to go"
Audit lead clinician Dr Gerry Rayman said: “Although it is pleasing to see there have been improvements in medication errors since the last audit there is a long way to go and indeed the majority of hospital doctors and ward nurses still do not have basic training in insulin management and glucose control”.
“Training needs to be mandatory to improve diabetes control and reduce the frequency of severe hypoglycaemia. It is also needed to prevent DKA occurring in hospital, for which there can be no excuse; its occurrence is negligent and should never happen."