Improving hospital care for people with diabetes – by David Jones

David Jones is Assistant Director of Improvement Support and Innovation at Diabetes UK. Here he explains how Diabetes UK is making a difference for people with diabetes in hospital.

There are major problems with diabetes care in hospital. If you have been in hospital you might have seen some of the problems. If you work in a hospital you definitely will have. I have been privileged to speak to many people with diabetes about their hospital experiences over the last 11 years. They have affected me hugely and have been a key part of my motivation to do something to improve care.

Nobody responded for 30 minutes

Lesley sums it up simply, “When I went into hospital for major surgery I felt in control of my diabetes. I felt fully supported thanks to the brilliant pre-assessment appointment. I took medication/foods into hospital so I could care of myself. I was shocked though when I came around from the operation that I was unable to do anything. Later in the evening I started to experience a hypo and could hear the monitor going off but there was no response. A nurse came, said it was okay and went away but the monitor kept on bleeping. Luckily a fellow patient intervened and alerted medics who helped and treated the hypo. Later talking with nurses I was shocked at the lack of knowledge of basic diabetes care.” Sadly, this kind of experience is more common than it should be.

Since 2010, the National Diabetes Inpatient Audit (NaDIA) has painted a picture of problems with care. People experience poor food choices, medication errors and become unwell unnecessarily. In more extreme cases people experienced lasting harm and, in rarer cases, have died.
The numbers make it clear we need a concerted national effort to improve care.

In 2016 there were:

  •  1 million admissions for people with diabetes
  • 125,000 hypos recorded – 12,500 requiring emergency treatment
  •  Nearly half of those treated with insulin experienced an error
  •  3,000 people needed treatment for Diabetic Ketoacidosis (DKA)

There have been efforts in the past to improve things. My first role at Diabetes UK, in 2007, included a big piece of work to involve people with diabetes in discussions about improving inpatient care. We brought about 50 people together with clinicians. I remember being upset by some of the stories but heartened by the commitment of our NHS colleagues to improve care.

That led to the Think Glucose programme and improvements in care in many hospitals. It showed me that improvement in care is possible and that it is best done as a collaboration between patients, healthcare professionals and managers.

Since then the NaDIA has shown that we still have a long way to go to get care to the point where it needs to be.
I have been impressed by the many, many people trying to improve care in local hospitals. We have been visiting hospitals all over the country and have seen a huge number of initiatives that are addressing some of the common issues.

Some hospitals have managed to deliver reductions in medications errors by introducing good systems and training for staff. Others have taken a ‘proactive’ approach – targeting people with diabetes as soon as they come into the hospital and making sure they get a plan and are reviewed. Increasingly hospitals are using new technology to remotely monitor the blood glucose of people, allowing them to target those most at risk. All this work is making a difference to people with diabetes in hospital, but more needs to be done to bring it together and to help other teams understand what they need to do.

Safe stay in hospital

At Diabetes UK, we have decided to throw our weight behind the problem. We will support national and local improvement programmes, and teams driving change and will coordinate their efforts through a Roadmap outlining a strategy for improvement with clear calls to action for everyone who can make a difference. We will also work with people with diabetes to make sure we know what they need to have a good and safe stay in hospital.

At Diabetes UK I ‘ve seen amazing work from wonderful people that is making a difference for people with diabetes in hospital. With a big collective effort we can build on all the good work and make a good and safe experience of hospital the norm for people with diabetes.

How can you help?

If you work in the NHS you can tell us about your own good practice but also about the challenges you’ve experienced. Check out our shared practice library for other examples. If you have diabetes and have been in hospital please tell us about the things that would help improve your experience of care in the future.
To get in touch email inpatientcare@diabetes.org.uk

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