A hospital stay for a person with diabetes can be a frightening experience and it is easy to understand why. In 2017, an estimated 9,600 people required rescue treatment following a severe hypoglycaemic attack. 2,200 people suffered from Diabetic Ketoacidosis (DKA) because of under treatment with insulin. We can and must do better for people with diabetes in hospital.
Use the following resources and tools to improve inpatient and hospital care for people with diabetes:
- Making hospitals safe for people with diabetes (October 2018) (PDF, 1074KB)
Self-assessment checklist (October 2018) (PDF, 509KB)
- Adapting the Ipswich Touch Test to increase foot risk assessments at the Royal Free Hospital, Diabetes UK (August 2016) (PDF, 173KB)
Download the tool featured in the bright idea (PDF, 42KB).
- How to grow your DSN's (PDF, 119KB)
- Joint British Diabetes Society: guidelines for inpatient care, Diabetes UK website
- NHS Digital: National diabetes inpatient audit results, NHS Digital website
- All Party Parliamentary Group (APPG) website: The future of diabetes inpatient care report
- NCEPOD report- Perioperative Diabetes: Highs and Lows
- DISN Group website
- A teachable moment: delivering perioperative medicine in integrated care systems
Shared practice examples
Developing your diabetes inpatient team
Everyone with diabetes has access to a range of healthcare professionals who can care for their complex needs. From their admission to discharge, they know they can contact the diabetes inpatient team if needed and will be cared for regardless of what day of the week it is.
- Example business case for diabetes team (PDF, 557KB)
- How to grow your DSN's (PDF, 119KB)
- Does the Diabetes Specialist Nursing Workforce impact the experience and outcomes of people with diabetes? A hermeneutic review of the evidence.
- Diabetes UK position statement on defining a Diabetes Specialist Nurse for adult services and a career and education framework for diabetes specialist nursing
- A seven day diabetes service for inpatients and the emergency department in an acute hospital setting, Future Hospital Journal Website
- Inpatient care for people with diabetes: The economic case for change (PDF, 10,597KB)
Engaging and Training frontline staff
No one with diabetes feels unsafe in hospital. Everyone with diabetes in hospital feels confident that those caring for them understand their needs. And healthcare professionals receive the training they need to offer the best care possible.
- Diabetes 10 point training programme for inpatients, Diabetes UK website
- Handbook for adult inpatient diabetes care, University Hospitals of Leicester
- DiAppBetes - an app to support non-specialists to care for people with diabetes in hospital
- Making Insulin Treatment Safer (MITS)
- Back to the floor, Queen Elizabeth Hospital, Birmingham (PDF, 823KB)
- IDEA – Inpatient diabetes education through animation, Leicester Hospitals, YouTube
- Moving Beyond the Classroom: simulation training on diabetes-related hypoglycaemia, West Suffolk NHS Foundation Trust (PDF, 507KB)
- Pocketmedic: Preventing hypos in hospital, PocketMedic website
E-learning training modules
- Diabetes in healthcare (free, login required)
- 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)
- Safe use of insulin in hospital – Cambridge Diabetes Education programme
Information for patients
People with diabetes know what care to expect in hospital and feel able to ask for it. People are able to self-manage their diabetes where appropriate and have access to the right food at the right time during their stay.
- Inpatient Information Sheet, Diabetes UK (PDF, 70KB)
- DKA patient information factsheet, University Hospitals Southampton (PDF, 148KB)
- Diabetes in Hospital, Diabetes Australia (PDF, 350KB)
- Diabetes: Managing your foot wound, University Hospitals Southampton (PDF, 129KB)
- Type 1 Inpatient Management Plan for Insulin Pumps, Type 1 Diabetes Family Centre (PDF, 932KB)
- Type 1 Inpatient Management Plan for Multiple Daily Injections, Type 1 Diabetes Family Centre (PDF, 806KB)
- Self-administration of insulin in hospital: a guide to support Trusts through the implementation process, Wessex Academic Health Science Network website
- Insulin self-administration: Development of an assessment tool to empower hospital inpatients with diabetes, University Hospitals Southampton
Patient assessment flowchart (PDF, 200KB)
Patient information sheet for self-administration (PDF, 199KB)
Systems and Technology
Systems are in place that allow the diabetes inpatient team to identify people with diabetes and assess their risk, responding to those most in need. So that people with diabetes experience fewer harms
- Identifying people with diabetes on entry to hospital (PDF, 228KB)
- Innovative use of ward glucose systems to reduce inpatient hypoglycaemia, Ipswich Hospital (Word, 27KB)
- Improving the management of inpatients on insulin, Harrogate and District NHS Foundation Trust (PDF, 23KB)
- Derby inpatient improvement project (DIPS) (PDF, 407KB)
- Insulin safety on discharge – Health Innovation Network South London website
Supporting hospitals to learn from mistakes
People with diabetes experience fewer harms in hospital because when errors occur, they are reported and action taken so they don't happen again. The diabetes inpatient team has processes in place to make sure mistakes are owned, understood and managed by the clinical teams involved.