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Results from latest diabetes inpatient audit

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The latest National Diabetes Inpatient Audit (NaDIA) has been published. The audit was carried out by the Health and Social Care Information Centre, in collaboration with Diabetes UK.

The clinical audit shows only 1.1 per cent of inpatients with diabetes developed a new foot lesion during their admission to hospital, a significant decrease from 2.2 per cent when inpatient auditing began in 2010.

But since 2010, similar improvements in the other two main hospital inpatient harms - severe hypoglycaemic episodes and diabetic ketoacidosis (DKA) - have not occured.

Other key findings from the audit:

* More than two thirds (67.0 per cent) of inpatients included in the audit did not have a specific diabetic foot risk examination during their hospital stay

* 31 per cent of hosptial sites still do not have a multi-disciplinary diabetic foot care team, despite being highlighted as important in each audit round

* The proportion of inpatients having one or more hypoglycaemic episode, since 2010, has reduced from 26.1 per cent to 21.8 per cent. However, there has been no significant reduction in the proportion of inpatients having one or more severe life threatening hypoglycaemic episdes that required emergency resue with injectable treatment (2.4 per cent in 2010 compared to 2.1 per cent in 2015)

* Since the audit began in 2010 there has been no reduction in the proportion of inpatients developing the severe life threatening and wholly preventable condition DKA after admission - 0.4 per cent in both 2010 and 2015

* The proportion of inpatients experiencing medication errors has increased from 37.0 per cent to 38.8 per cent since the previous audit in 2013.

Rise in the number of people in hospital with diabetes

The percentage of hospital beds occupied by people with diabetes has risen each year from 14.6 per cent in 2010 to 16.8 in the latest audit (2015).

Chris Askew, Chief Executive of Diabetes UK, said: “We welcome the audit report and the improvements to hospital care for patients with diabetes since it began in 2010 but there is still much cause for concern. Currently one in three hospitals does not have a single diabetes specialist nurse, and almost 40 per cent of people with diabetes, who may or may not be in hospital because of their diabetes, are nonetheless experiencing medication errors.

Diabetes specialist staff are vital

“Having diabetes specialists in place is a vital step to addressing early on, or even avoiding, devastating and costly complications. Their impact also extends to other hospital staff as they play a valuable role in training and building up their understanding of diabetes and the healthcare needs of patients with this complex condition helping to ensure these are met every time.

“The current lack of specialist staff and subsequent medication errors mean patients continue to be put at increased risk of having a severe hypoglycaemic episode or diabetic ketoacidosis, both of which can be life-threatening but are largely preventable.

“Inpatients with diabetes account for one in six hospital beds, yet less than 60 per cent of those who responded to the patient experience questionnaire said they were able to take control of their diabetes care when they were in hospital.

Dissatisfaction with hospital meals 'a stark wake up call'

“Over a third of inpatients with diabetes reported the hospital did not always provide the right choice of food for them to manage their diabetes – a basic but critical health need. This significantly higher level of dissatisfaction, compared with the last audit, over something which should be relatively simple to deliver, especially in a healthcare setting, is a stark wake up call for hospitals to ensure the nutrition needs of their diabetes patients are being met. 

"This is why we are calling on commissioners to include, in their contracts with hospitals, requirements for the provision of the recommended standards of diabetes care. Hospitals should have a diabetes inpatient specialist team to respond to referrals and provide support and training to generalist staff.  Improvements must be made to inpatient care from reviews of patient safety standards to ensuring that hospitals have a specialist multi-disciplinary foot care team; until this happens people with diabetes and the NHS budget will continue to pay the price for less than optimum care.”

The National Inpatient Diabetes Audit (NaDIA) 2015 was carried out by diabetes teams in acute hospitals in 135 Trusts in England and 6 Local Health Boards in Wales on a nominated day in September. It covers issues such as staffing levels, medication errors, patient harm and patient experience. The 2015 audit surveyed 15,299 patients with diabetes.

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