Publication, Part of National Diabetes Inpatient Safety Audit (NDISA)

National Diabetes Inpatient Safety Audit (NDISA) 2018-2021

Audit

Publication Date:: 14 Jul 2022
Geographic Coverage:: England, Wales
Geographical Granularity:: Hospital Trusts
Date Range:: 01 May 2018 to 31 Oct 2021

Executive summary

Key findings

Key findings: Inpatient service provision

The National Diabetes Inpatient Safety Audit (NDISA) reviewed inpatient service provision in England and Wales against the 2020 Diabetes Getting It Right First Time (GIRFT) recommendations.

6 inpatient-specific GIRFT recommendations were assessed for this report. The proportion of healthcare providers meeting each GIRFT recommendation can be seen in Chart 1.1.

Download the data for this chart Chart 1.1: Percentage of responders that fully met each GIRFT recommendation, England and Wales, October 2021

Findings:

Service coverage ranged from:

72% of healthcare providers providing insulin training for appropriate staff [GIRFT recommendation 8]; and 72% having a self-management policy [GIRFT recommendation 10]; to

Only 27% of providers having a system to identify people with diabetes on admission, prioritising those at highest risk, involving networked blood glucose (BG) meters [GIRFT recommendation 7]

The full text of each GIRFT recommendation is on the associated page later in the report. Brief descriptions of the GIRFT recommendations are below:
5. Dedicated multi-disciplinary inpatient diabetes teams (MDiTs): provision and weekend cover (actual or planned) (Go to page).
6. Dedicated MDiTs: meeting and reporting (Go to page).
7. Identifying diabetes on admission and ensuring rapid referral (Go to page).
8. Reducing insulin errors (Go to page).
9. Improving care through perioperative pathways (Go to page).
10. Supporting self-management in hospital (Go to page).

Key findings: Inpatient harms

NDISA has reviewed the rate of 4 life-threatening diabetes-specific inpatient harms that occurred due to errors of inpatient diabetes management in England between Q1 2019 (Jan-Mar) and Q3 2021 (Jul-Sep): inpatient onset of hypoglycaemia requiring rescue, diabetic ketoacidosis (DKA), hyperosmolar hyper-glycaemic state (HHS) and diabetic foot ulcer (DFU).

Chart 1.2: Inpatients with diabetes, by quarter: rate of inpatient harms: hypoglycaemic rescue, DKA, DFU and HHS, England (rounded[1])

Download the data for this chart Chart 1.2: Inpatients with diabetes, by quarter: rate of inpatient harms: hypoglycaemic rescue, DKA, DFU and HHS, England (rounded[1])

Notes: 1. Proportions are derived from rounded values. Underlying counts between 1 and 7 are set to 5. All counts greater than 7 are rounded to the nearest 5.

Findings:

The rate of total inpatient harms decreased by almost 40% from 26.3 per 100,000 occupied bed days in Q1 2019 (Jan-Mar) to 16.2 in Q3 2021 (Jul-Sep) (see Chart 4.2). Chart 1.2 shows that this trend is largely driven by reductions in hypoglycaemic rescue (from 18.9 to 11.1), which comprise 69% of total inpatient harms. There was also a small peak in Q2 2020 (Apr-Jun) of 15.2, coinciding with wave 1 of the COVID-19 pandemic.

Although the DFU rate follows a similar downward trend (3.2 to 1.4), there was no apparent reduction in the rate of inpatient DKA or HHS.

Recommendations

NDISA recommendation 1:

All NHS Trusts in England and LHBs (Local Health Boards) in Wales should participate in NDISA data collection.

Why? NDISA is a mandatory national audit. Participating in data collection allows healthcare providers to check compliance with GIRFT recommendations, to monitor adverse inpatient diabetes outcomes and to benchmark against their peers. This allows them to understand their current position and identify areas for improvement.

What the audit tells us: Of 126 organisations eligible for NDISA, 85 (67%) responded to the specialist services structures survey and 109 (87%) have at some time submitted harms data with 63 (50%) submitting data regularly.

NDISA recommendation 2:

Healthcare providers, NHS trusts in England and LHBs in Wales, should have a MDiT and be working towards providing base-level diabetes cover at weekends.

Why? The MDiT plays a central role in providing safe, effective inpatient diabetes care. For this reason, the NHS Long Term Plan (3.81), the 2019 National Diabetes Inpatient Audit (NaDIA) report (recommendation 3) and the 2020 GIRFT report (recommendation 5) have all previously made this recommendation.

What the audit tells us: 13% of healthcare providers still do not have an MDiT in spite of these recommendations (see Inpatient service provision Table 3.2). Only 32% of healthcare providers currently have both an MDiT in place and provide cover at weekends, a further 27% have an MDiT in place and are working towards weekend cover (Inpatient service provision Table 3.2).

NDISA recommendation 3:

Healthcare providers should have networked BG meters to alert staff when recorded glucose levels are out-of-range (increased risk).

Why? Networked BG meters can alert the MDiT to high and low BG readings when they occur, directing support to those most in need. They also allow audit and review of glucose readings, permitting ongoing review of the overall safety and effectiveness of inpatient diabetes care. This supports GIRFT recommendation 7.

What the audit tells us: Only 56% of healthcare providers have networked BG meters with a system to alert the diabetes team to out-of-range BG values (see Inpatient service provision Table 3.4).

NDISA recommendation 4:

All participating organisations should have a policy to support diabetes self-management in hospital.

Why? 17% of inpatients are people with diabetes. They are experts in self-management and often feel unsafe when handing over their diabetes management to others in hospital. The issue has been highlighted as of particular importance by people living with diabetes who are part of the NDISA advisory group.

What the audit tells us: 72% of responding organisations report having a self-management policy. For people with diabetes, it is a priority that these policies become universal and that they are promoted in line with GIRFT recommendation 10.

Last edited: 14 July 2022 9:33 am