Around 15 per cent of all hospital beds in the UK are occupied by people with diabetes. People with diabetes who are admitted to hospital must be cared for by appropriately trained staff, provided with access to a specialist diabetes team and given the choice of self monitoring and managing their own insulin.
Hypo awareness week will run from the 24-30th September 2018. Register online to receive your free resource pack.
Use the following resources and tools to improve inpatient and hospital care for people with diabetes:
- Essential reading for improving your inpatient diabetes service
- Shared practice examples
- Resources for creating a case for change
- Adapting the Ipswich Touch Test to increase foot risk assessments at the Royal Free Hospital, Diabetes UK (August 2016) (PDF, 173KB)
This bright idea describes how the Royal Free Hospital created a foot risk assessment tool based on the Ipswich Touch Test. Since introduction of the tool, the percentage of people with diabetes who received a foot risk assessment on admission increased from 6.5 per cent in 2013 to 40 per cent in 2015. Download the tool featured in the bright idea (PDF, 42KB).
- Joint British Diabetes Society: guidelines for inpatient care, Diabetes UK website
- NHS Digital: National diabetes inpatient audit results, NHS Digital website
- Diabetes Think, Check, Act resources, Health Improvement Scotland website
- Inpatient care for people with diabetes: The economic case for change (PDF, 10,597KB)
- The NHS Getting it Right First Time (GIRFT) programme website
- All Party Parliamentary Group (APPG) website: The future of diabetes inpatient care report
- NHS RightCare pathway: Diabetes
- Diabetes Quality in Care website: award winners
- Clinical practice guidelines and resources, Canadian Diabetes Association website
Engaging and training frontline staff
Ruth Miller, Diabetes UK Clinical Champion, developed a training programme when she observed that many diabetes inpatients have their care delivered by non-specialists. Since introduction of the training at Poole Hospital, medication errors have reduced from 46.9 percent in 2015 to 26.7 percent in 2016.
DiAppbetes provides concise guidance notes that cover a wide variety of key themes. The app can be downloaded and edited for different hospitals.
Diabetes back to the floor involves periodic diabetes care quality review at ward level followed by formative feedback to staff.
- Inpatient diabetes education tool for doctors in training (INDIE), Leicester Diabetes Centre website
INDIE forms the basis for a blended inpatient diabetes educational tool which includes a web based educational resource (including knowledge survey, links to educational material and guidance.)
Inpatient Diabetes Education through Animation – (IDEA) involves a series of short cartoons based on real life scenarios, developed by trainee doctor, Sowmya Gururaj.
E-learning training modules
- Diabetes in healthcare (free, log in required) – an introductory diabetes education tool for healthcare professionals covering Type 1 and Type 2 diabetes
- Six steps to insulin safety (free, log in required) – an essential module for all those prescribing, managing or administering insulin, with the overall aim of reducing insulin errors in clinical practice
- Think, Check, Act e-learning modules, NHS Scotland quality improvement hub website (free, login required)
- Secondary care, education for general staff, diabetes education Scotland website (free)
Dr Parijat De, Consultant in diabetes and endocrinology and Diabetes UK Clinical Champion, piloted a condensed version of the original DKA management and monitoring chart developed by the JBDS-IP committee.
This factsheet has been designed by Southampton Hospital for patients experiencing DKA.
- Innovative use of ward glucose systems to reduce inpatient hypoglycaemia, Ipswich Hospital (Word, 27KB)
The DICE (diabetes inpatient care and education) team optimised use of their blood glucose monitors to identify trends in hypoglycaemia and introduced new initiatives to reduce levels.
- Improving the quality of assessment and management of hypoglycemia in hospitalised patients with diabetes mellitus by introducing 'hypo boxes' to general medical wards with a specialist interest in diabetes, BMJ Quality Improvement website (2015)
This article shows how 'hypo boxes' can improve the assessment and management of episodes of hypoglycaemia in inpatients with diabetes.
Pocket medic and Diabetes UK Clinical Champion, Dr Sam Rice, have created a video to help health care professionals recognise and treat hypoglycaemia.
- Self-administration of insulin in hospital: a guide to support Trusts through the implementation process, Wessex Academic Health Science Network website
This guide supports Trusts through the process of setting up safe and robust arrangements for routine self-administration of insulin. Part 1 helps Trusts to make a case for change and Part 2 provides step by step guidance on how to implement and measure self-administration of insulin throughout a hospital.
- Improving the management of inpatients on insulin, Harrogate and District NHS Foundation Trust (PDF, 23KB)
A multi-disciplinary group was created to develop a programme of work to improve the safe use of insulin.
- Derby inpatient improvement project (DIPS) (PDF, 407KB)
The Derby Insulin Safety Group introduced change at multiple levels to improve the standards of all aspects of diabetes care in the hospital.
To improve patient care and safety the diabetes team trialled a new way of working in the Clinical Decision Unit.
In Sheffield, the pharmacy team led a series of projects to increase the number of people able to self-manage in hospital. This resulted in a change of policy permitting patients to keep insulin in their possession and to continue self care
This guide developed by the Health Innovation Network (HIN) sets out recommendations using validated tools to help improve insulin safety on discharge
- Improving in-hospital awareness of different insulins – insulin profile sheet, Lister Hospital (JPEG, 3.28MB)
- Insulin Profile poster, University Hospital of Leicester NHS Trust (PDF, 257KB)
- NHS Improvement, Risk of severe harm and death due to withdrawing insulin from pen devices. Patient safety alert, NHS Improvement website
- A seven day diabetes service for inpatients and the emergency department in an acute hospital setting, Future Hospital Journal Website
This case study describes how the East and North Herts Diabetes Outreach Team (DOT) introduced seven day a week access to diabetes specialists for inpatients.
Making change happen in hospitals can be difficult. These resources will help you create a case for change and engage your team in improvement.
Engage your workforce in Quality Improvement
This app has been designed to enable students and staff to feedback and suggest improvements to services, breaking down typical levels of hierarchy and allowing the whole workforce to engage in improvement.
Using data to drive change
This NaDIA benefits case study describes the service and pathway changes in inpatient diabetes care services that hospitals and trusts have initiated as a result of NaDIA findings.