National Diabetes Inpatient Safety Audit

Access for registered users

An annual NDISA dashboard is available from the NDA dashboard hub. This dashboard presents trust and service level participation and submission of harms data as well as information extracted from the Integrated Specialist Services (ISS) survey.

The Department of Health and Social Care directed NHS Digital (now NHS England) to carry out this work in response to concern over the increase in prevalence of diabetes in the population and the associated long-term health implications.

The audit records the details of any adult who has one of four avoidable complications which can occur in inpatients with diabetes.

Linking with other health datasets allows the identification of high-risk demographics which enables the development of proactive processes to reduce the occurrence.

The audit collects data on four harms which can occur to inpatients with diabetes:

Severe inpatient hypoglycaemia

From 1 April 2024, the hypoglycaemia harm criteria will change to a threshold definition: a blood glucose measurement of less than 2.2 mmol/l in a person with diabetes, occurring more than 6 hours into an admission episode, irrespective of treatment regimen and reason for admission.

If multiple qualifying measurements are taken over a short period of time, please limit the hypoglycaemia harm recording to once every 24 hours. Different types of harms may still be recorded within this period.

This change has been made to assist with the automated identification of harms from electronic hospital systems.

There is no change with the way a harm is recorded on the data entry platform.

Diabetic Ketoacidosis (DKA)

‘Was the patient diagnosed with new onset DKA more than 24 hours after admission?’

DKA requires three key features for diagnosis:

• known diabetes or blood glucose over 11.0 mmol/l
• Ketonaemia (blood ketones 3.0 mmol/l or more) or urine ketones 2+ or more
• Acidosis with venous pH less than 7.3 or bicarbonate less than 15 mmol/l

For more on the definition of DKA please refer to the JBDS guidelines on the ABCD web site.

Hyperglycaemic Hyperosmolar State (HHS)

‘Was the patient diagnosed with new onset HHS more than 24 hours after admission?’

HHS has characteristic features used in its diagnosis:

• Hypovolaemia
• marked hyperglycaemia (blood glucose 30 mmol/l or more) without significant ketonaemia (blood ketones less than 3 mmol/l) or acidosis (venous pH 7.3 or more/bicarbonate 15 mmol/l or more)
• Osmolality usually 320 mosmol/kg or more

For more on the definition of HHS please refer to the JBDS guidelines on the ABCD web site.

Diabetic foot ulcer

‘Was the patient diagnosed with a new onset foot ulcer more than 72 hours after admissions?’

The audit is not intended to collect reports of foot ulcers that are present on admission, or which develop within 3 days of admission. Grade 2+ Pressure sores on the foot that develop more than 72 hours after admission should be included. Deep tissue injury which has not progressed to skin ulceration is not included. Traumatic skin foot lesions and foot infections which arise during the admission are included.

For further information about the audit, email [email protected].

For general enquiries, email [email protected] call 0300 303 5678 (Monday to Friday 9am to 5pm).