Diabetic patients developing preventable life-threatening complications in hospital June 27th, 2013 admin Latest News Shares Comments Diabetic patients developing preventable life-threatening complications in hospital In just one week more than 60 hospital inpatients with diabetes developed a life-threatening but preventable complication, according to a national audit report released today. The report says it is “shocking” that patients should develop diabetic ketoacidosis (DKA) during their hospital stay and calls for a change in culture to recognise and address problems earlier. DKA is a potentially life-threatening complication, resulting from a severe shortage of insulin. The findings are published today in the National Diabetes Inpatient Audit (NaDIA), which is managed by the Health and Social Care Information Centre, working in collaboration with Diabetes UK and commissioned by the Healthcare Quality Improvement Partnership. The report also found that the majority of hospitals in England and Wales made medication errors (6). During the five days of the audit, more than a third of patients with diabetes experienced a medication error. NaDIA examined data collected by hospital teams in England and Wales about inpatients with diabetes over a five-day period in September 2012, covering issues such as staffing levels, medication errors and patient experience. It involved 13,410 patients with diabetes in 136 trusts in England and six local health boards in Wales. Over this period, 15.3% of inpatient beds were occupied by people with diabetes. The aim of the NaDIA is to drive improvements in care for inpatients with diabetes. The majority of patients included in the audit were admitted for medical reasons other than diabetes, with just 8.2 per cent in England and 9.6 per cent in Wales admitted specifically for the management of their diabetes. The data shows: Diabetes ketoacidosis • 59 inpatients (0.5 per cent) in England were reported to have developed DKA after their admission to hospital, which was similar to 2011 (65 patients or 0.6 per cent) and 2010 (44 patients or 0.4 per cent). • Two patients (0.2 per cent) in Wales were reported to have developed DKA after their admission to hospital, which was similar to 2011 (three patients or 0.3 per cent). • While the percentage of patients affected is low, this life-threatening condition is entirely preventable. Hypoglycaemia • 20.4 per cent of patients in England and 20.7 per cent in Wales experienced a mild hypoglycaemic episode whilst in hospital and 10.5 per cent of patients in England and Wales experienced a severe hypoglycaemic episode whilst in hospital (7). • These harms are largely avoidable Medication errors • Medication errors in England have reduced. Around one third (39.8 per cent) of inpatients in England included in the audit experienced at least one medication error while in hospital, compared to 40.0 per cent in 2011 and 44.5 per cent in 2010. • In Wales over one third (36.7 per cent) of inpatients included in the audit experienced at least one medication error while in hospital, which was similar to 38.3 per cent in 2011. • Insulin prescribing errors decreased, particularly the unsafe practice of abbreviating units to ‘U’ on prescribing charts (down to 2.6 per cent of charts in England from 6.3 per cent in 2010 and down to 1.8 per cent of charts in Wales from 2.1 per cent in 2011). This error can result in a fatal 10 fold insulin overdose as for example 10u can be misread as 100 units. Staffing levels • Among the inpatients who should have seen a specialist diabetes team, just 58.5 per cent of the inpatients in England and 59.0 per cent in Wales actually saw one. • 32.2 per cent of sites in England and 47.1 per cent in Wales had no diabetes inpatient specialist nurse provision for inpatient care. • 7.0 per cent of sites in England had no consultant time for inpatient care for people with diabetes. In Wales all sites had at least some consultant time. • 78.4 per cent of sites in England and 64.7 per cent in Wales did not have any specialist dietician time for inpatient care for people with diabetes Podiatry • For patients admitted specifically for a diabetes complication, 44.2 per cent in England and 56.7 per cent in Wales were admitted with active foot disease(8). • All patients with diabetes should have a foot examination on admission This occurred at some point during their stay for 35.1 per cent of inpatients with diabetes in England (compared to 26.8 per cent in 2011 and 28.2 per cent in 2010). In Wales just over a fifth (21.7 per cent) of inpatients had a foot assessment at any time (compared to 13.4 per cent in 2011). • All patients with active foot disease should be seen within 24 hours by a member of the multidisciplinary foot team however this occurred in just over half (53.9 per cent) of those patients admitted with active diabetic foot disease in England and just under half (46.6 per cent) in Wales. Only two thirds (66.7 per cent) in England and just over half (51.7 per cent) in Wales were seen at any time during their hospital stay. • There has been an increase in the number of sites with no inpatient podiatrist provision in England (from 26.8 per cent in 2010 to 31.2 per cent in 2012) and in Wales (from 22.2 per cent in 2011 to 47.1 per cent in 2012). Patient satisfaction • The majority of inpatients in England (85.7 per cent) stated they were very satisfied or satisfied with their diabetes care while in hospital (compared to 84.9 per cent in 2011 and 80.8 per cent in 2010) and 21.1 per cent of inpatients reported that they had definitely been involved in the design of their care plan. • In Wales 84.8 per cent stated they were satisfied or very satisfied with their diabetes care while in hospital (similar to 84.1 per cent of in 2011) and 20.2 per cent of inpatients reported that they had definitely been involved in the design of their care plan. Audit lead clinician Dr Gerry Rayman said: ““The purpose of this annual audit is to drive improvements in care for inpatients with diabetes, so I am pleased to see there has been some progress on problems highlighted in previous years’ reports, for instance around insulin prescribing. But staffing levels remain low, and it is of grave concern that some patients are developing DKA, which is a potentially life-threatening complication in hospital. This is due to their needs being neglected and should simply never happen.” Submit News Contact us with your community, business or sport news. Phone 07930717137 Email [email protected] Twitter www.twitter.com/onthespot_news Breaking local news as it happens, searchable archives with photographs, the ability to instantly comment on news articles – there are so many advantages to OTS (Onthespot) News. If you want your news read locally online then send it to [email protected] – relying only on the newspaper is to restrict yourself to an ever reducing audience. Onthespot – your online reporter www.onthespotnews.co.uk Do you have a story to tell? Call OTS www.callots.co.uk Please text or phone 07930717137 or email [email protected] Follow OTS (Onthespot) on Twitter www.twitter.com/onthespot_news Related Comments comments!