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18May

Nearly one in three hospital patients with diabetes are affected by errors which can result in dangerously high blood glucose levels, according to a national audit report.

Hospitals in England and Wales made at least one medication error in the treatment of 3700 inpatients with diabetes in one week, according to the National Diabetes Inpatient Audit (NaDIA).

This is a small improvement on the previous year according to the audit, which is managed by the Health and Social Care Information Centre in partnership with Diabetes UK and commissioned by the Healthcare Quality Improvement Partnership.

During the seven day audit period, the patients with errors suffered more than double the number of severe hypoglycaemic – “hypo” – episodes compared to patients without errors. Hypos occur when blood glucose levels drop dangerously low and if left untreated can lead to seizures, coma or death.

In addition, 68 patients developed diabetic ketoacidosis (DKA) during their stay in hospital. DKA occurs when blood glucose levels are consistently high which suggests that insulin treatment was not administered for a significant period of time. DKA can be fatal if not treated.

The audit examined bedside data for 12,800 patients and 6600 patient questionnaires, covering subjects including medication errors and patient harm over a seven day period in October 2011. It involved 11,900 patients in 212 English hospitals and 900 patients in 18 Welsh hospitals. As this is the first year that Welsh data have been included, the following comparative findings cover England only. Data show that in the seven days:

  • 32.4 per cent of patients (3,430) experienced at least one medication error in the previous seven days of their hospital stay. This is a small improvement on the previous year (36.6 per cent, or 4,120, in 2010).

Medication errors were recorded under two types: “prescription error” or “medication management error” and some patients experienced both types while in hospital.

Prescription errors

  • 20.7 per cent (2,190) of patients with diabetes experienced a prescription error. This is an improvement on the previous year (25.5 per cent or 2,870 in 2010).
  • Of those patients, the most common error was failing to sign off on the patient’s bedside information chart that insulin had been given, which happened to 11.1 per cent of patients (440). This is an improvement on the previous year (12.7 per cent or 530 in 2010).

Medication management errors

  • 18.4 per cent (1,950) of patients with diabetes experienced medication management errors. This is an improvement on the previous year (19.7 per cent or 2,210 in 2010).
  • Of those patients, the most common error was failing to appropriately adjust medication when they had a high blood sugar level, which happened to 23.9 per cent (800). This is an improvement on the previous year (27.9 per cent or 880 in 2010).
  • 17.4 per cent, (600) of patients with medication errors had a severe hypoglycaemic attack while in hospital, compared to 7.5 per cent (550) of patients without medication errors.

65 patients (0.6 per cent) developed diabetic ketoacidosis while in hospital. This is worse in number than in the previous year (44 patients or 0.4 per cent in 2010).

Audit lead clinician Dr Gerry Rayman said: “Although it is pleasing to see there have been improvements in medication errors since the last audit there is a long way to go and indeed the majority of hospital doctors and ward nurses still do not have basic training in insulin management and glucose control”.

“Training needs to be mandatory to improve diabetes control and reduce the frequency of severe hypoglycaemia. It is also needed to prevent diabetic ketosis occurring in hospital, for which there can be no excuse; its occurrence is negligent and should never happen.

“However, controlling diabetes at the best of times can be difficult in some patients; more so if they are ill and unable to eat and drink. This is why the knowledge, experience and skills of diabetes specialist staff are so important. There is no doubt that big improvements in care and patient safety can happen by ensuring hospitals are adequately staffed with inpatient diabetes specialist teams, who can provide leadership, governance and training to other hospital staff.”

The report can be accessed from May 17 at www.ic.nhs.uk/nda

The results of a second major study into diabetes care, carried out by Diabetes Health Intelligence (Yorkshire and Humber Public Health Observatory), have also been issued today. Mortality Amongst Inpatients with Diabetes, found hospital inpatients with diabetes are 10 per cent more likely to die than those without the condition.

Written and supplied by the Health and Social Care Information Centre

  

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