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Ward audit reinforces importance of need for having diabetes specialist nurses

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More than a quarter of hospitals still have no specialist diabetes nurses, despite their crucial role in improving the wellbeing of those with the condition, reveals a national audit.

The National Diabetes Inpatient Audit (NaDIA) for England and Wales in 2016, published by NHS Digital, found 27.5% of hospitals had no specialist diabetes inpatient nurses.

“It is vital more diabetes specialist nurses are put in place”

Chris Askew

The report’s authors, who found virtually no change in staffing levels when it came to specialist diabetes nursing care, called for action to address shortages.

They also called for more work to address high levels of medication errors for diabetes patients that could lead to potentially life-threatening complications.

The audit measures the quality of care provided to people with diabetes admitted to hospital for any reason. In all, 209 sites took part in the 2016 audit, submitting data on more than 15,700 inpatients.

It shows the percentage of hospitals with staffing deficiencies has reduced slightly over the past five years. In 2011, 31.9% had no specialist diabetes inpatient nurses, while that was down to 27.5% in 2016.

However, there has been very little change in the hours of specialist nursing care per patient with diabetes.

In 2015, the hours of care per inpatient with diabetes from a specialist nurse was 0.67 and that had dropped very slightly to 0.66 in 2016.

Hours of care per patient from a diabetes inpatient specialist nurse dropped from 0.5 to 0.49, and hours of care per patient by a diabetes specialist nurse stayed the same at 0.17.

“NaDIA has now highlighted staffing issues for six years, but there has been no change in dedicated inpatient diabetes staffing levels,” stated the report.

“There has been no change in dedicated inpatient diabetes staffing levels”

Audit report

In the face of increasing numbers of inpatients with diabetes, it called on hospitals to “ensure that inpatient diabetes teams are adequately staffed to support other healthcare professionals and patients in the delivery of safe diabetes care”.

It said trusts should review staffing levels and apply for extra funding from NHS England’s Transformation Fund.

The audit highlighted consistently high levels of medication errors, with nearly two in five – 38% – of patients with diabetes experiencing a medication error during their hospital stay in 2016.

Nearly half – 46% – of inpatients who needed insulin experienced errors with insulin treatment.

The audit found errors, such as the incorrect timing of insulin administration and failing to address hyperglycaemia in insulin-treated patients, have got worse.

In 2016, around one in 25 people with type 1 diabetes developed diabetic ketoacidosis – a potentially life-threatening complication – in hospital, because they were not given enough insulin.

The report urged healthcare providers to learn from trust and local health boards that have successfully used electronic prescribing and other technology to reduce errors.

Meanwhile, it said diabetes teams should “continue to educate and support junior doctors and nursing staff, while also developing and testing new systems to reduce prescribing and medication management errors”.

There was evidence of improvements in care with the proportion of people with diabetes seen by the diabetes team – where this was appropriate – increasing from 58% in 2011 to 69% in 2016.

However, three out of 10 people – 31% – were are not seen by the diabetes team when they really should have been.

Tellingly, the report found a higher proportion were seen by the diabetes team when there was seven-day cover provided by specialist diabetes nurses.

Where specialist nurses were available all week, 73% were seen, compared to 69% where a seven-day service was not in place.

“The increase in the percentage of patients who should be seen by the diabetes team who were actually seen is impressive,” said the report. “There has been no increase in staffing since 2011, so this improvement must reflect greater efficiency and effectiveness.”

The report said every trust and health board should have seven-day diabetes inpatient specialist nurse provision, and ward referral systems should be in place to ensure all patients – where appropriate – were swiftly referred and seen by diabetes teams.

The audit also included a patient questionnaire, with five out of six reporting they were “satisfied” or “very satisfied” with their diabetes care during their hospital stay.

However, patients also flagged up the need to boost staff knowledge of diabetes and expressed concern about lack of diabetes specialist nurses.

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Chris Askew

Chris Askew

“I was surprised to see that over a quarter of hospitals still have no diabetes inpatient specialist nurses,” said one survey respondent called Sarah, who has type 1 diabetes. “I’d feel more confident going into hospital if I knew that both I and the team caring for me would have the support of a nurse with that specialist knowledge.”

Responding to the audit results, the charity Diabetes UK said it was “heartening” to see some improvements in care. But its chief executive, Chris Askew, said the audit clearly demonstrated the need for more specialist nurses.

“It is vital more diabetes specialist nurses are put in place, given they are central to the care of people with diabetes,” he said.

“While one in six inpatients have diabetes, and numbers are rising, more than a quarter of hospitals don’t have specialist nurses to support them,” he added.

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