New figures published today (Wednesday, 14 March) have found that people with diabetes are still receiving poor care in certain areas of England and Wales when they stay in hospital, despite positive changes being made across some hospitals, and years of hard work by diabetes inpatient teams.
Figures from the National Diabetes Inpatient Audit 2017 reveal that, despite important improvements, almost a third of inpatients (31%) with diabetes experienced a medication error, and around one in five (18%) had a hypo during their hospital stay.
The data reveals there has been no improvement in the number of inpatients with Type 1 diabetes affected by diabetic ketoacidosis (DKA). One in 25 inpatients (4%) have had hospital-acquired DKA, which is an extremely serious and potentially life-threatening condition if not treated quickly.
The audit also showed more than a quarter (28%) of hospitals do not have a dedicated inpatient specialist nurse and, while there has been an improvement in the proportion of people with diabetes being seen by a specialist diabetes team where appropriate, 28% of people still did not receive this.
We have called for the NHS England Transformation Funding to continue funding diabetes specialist inpatient nurses in hospitals beyond April 2019.
There are now around one in six (18%) hospital beds in England and Wales occupied by someone with diabetes, and this is set to increase. This is putting notable pressure on staff and hospitals. It is important diabetes is a priority for all hospital trusts, and staff receive the training they need to support this increasing number of patients.
We are calling for all hospitals to make sure people with diabetes are safe in hospital. The stark variation in the audit results across hospitals show that more needs to be done to help teams learn from one another. We have gathered examples of good practice in hospital care for patients with diabetes for teams to access, which can be found in our shared practice library.
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% reduction in severe hypoglycemic rates, a 40% 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.”
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.”
Phil Hayward went into hospital in 2015 after contracting food poisoning. He has Type 1 diabetes and was experiencing a hyper at the time. When he arrived at hospital he was put in a secluded room for two and a half hours before he was given any treatment for his diabetes. He said:
“I was very anxious as my blood glucose levels were not going down and I was frightened I was going into DKA, which is life-threatening. Luckily after a couple of hours I was able to get help from a doctor who was able to treat my hyper.
“This experience has made me incredibly anxious about going into hospital again. As someone with Type 1 diabetes, I am very reliant on hospital staff understanding my condition and managing it if I am unable to do so. It is important doctors and nurses are educated about diabetes and receive training so what happened to me doesn’t happen to anyone else.”
Gerry Rayman and David Jones will be presenting the data from the National Diabetes Inpatient Audit at the Diabetes UK Professional Conference (DUKPC) on Wednesday 14 March 2018.