Clinicians develop standards of care for diabetes patients in hospital

Clinicians in Southampton have pioneered the development of a set of standards to ensure patients with diabetes receive the specialist care they require when in hospital.

Led by Dr Mayank Patel, lead consultant in diabetes at University Hospital Southampton NHS Foundation Trust, the innovative scheme provides guidance for all medical and nursing staff on what steps to take to meet patients’ needs.

Up to 20% of all adults in UK hospitals have the condition, which affects the body’s ability to process sugar – glucose – and means they may require insulin or tablets to regulate blood sugar levels.

Although some patients are admitted as a direct result of diabetes, many require treatment for unrelated health problems and are cared for by staff without the expertise to manage the condition alongside other illnesses, increasing the risk of insulin or medication errors.

The standards set out by Dr Patel and his team include a number of simple processes which can be rolled out across hospital wards for all staff regardless of specialty, including the use of a ‘ThinkGlucose’ logo on patient status boards on wards to identify anyone with diabetes.

In addition, doctors and nurses should ensure a foot disease assessment is performed and results recorded within 24 hours of admission and that insulin or oral diabetes medications are given at or before mealtimes as recommended.

Clinicians are also expected to provide initial, immediate and appropriate action for managing low blood sugar levels, known as hypoglycaemia, and high blood sugar levels, known as hyperglycaemia, as well as referral to the inpatient diabetes team when required.

Under the standards, the diabetes team at UHS, which includes five specialist nurses, a research dietitian, an advanced specialist pharmacist and a lead consultant, is responsible for patient reviews, providing educational materials for staff, patients and families and a diabetes discharge plan where necessary.

The team also investigates and disseminates learning from incidents and reviews any re-admissions due to uncontrolled diabetes with healthcare partners in the community. The standards also encourage patients to take responsibility for ensuring they inform staff if they require diabetes support.

“We know almost a quarter of all adult patients in UK hospitals have diabetes at any one time and patients can spend anywhere between an additional three to five days in hospital if their condition is neglected,” explained Dr Patel, who was recently named a local champion for Diabetes UK for his continuous work in raising awareness and seeking to improve diabetes care.

“The introduction of simple and clear minimum standards of care for all adult patients with diabetes will give clinicians and their patients the best foundation to provide the right care for the duration of a hospital admission.”

Dr Patel said diabetes management was one of many areas competing for resources in the NHS and trusts should utilise IT to help meet training and educational needs.

"There is a need to use IT more smartly in the NHS as a whole, but inpatient diabetes is a particular example of where it can be extremely useful in helping clinicians to provide the best possible care in a cost-effective way," he said.

In addition to e-learning and online training packages, he suggested smartphone and tablet apps – including DiAppBetes, developed by Dr Patel and critical care consultant Dr Sanjay Gupta in Southampton – could play an increasingly important part in the future of healthcare provision.

DiAppBetes, which has recently been updated and is the most comprehensive diabetes support app available to clinicians, provides key information to help support non-specialist doctors and nurses who treat patients with the condition.

Dr Patel added: "We are very keen adopters of new technology in Southampton and are delighted to be able to support clinicians across the NHS with this tool.

"Inpatient diabetes management has steadily scaled the priority list in recent years and, through the development of these standards of care and technology, we hope that will continue to be the case in Southampton and throughout the NHS."

Dr Partha Kar, associate national clinical director for diabetes for NHS England, said: “The NHS is at a juncture where we are looking for innovations while, in the world of diabetes, inpatient issues have continued to be a major issue to tackle.

“In that environment, DiAppBetes is to be lauded as an excellent piece of innovation which needs to be adopted not only locally but across the NHS.”

Posted on Wednesday 6 July 2016