The work of a dedicated inpatient diabetes care team in a district general hospital

Abstract

We describe the work of a multidisciplinary inpatient diabetes care team in a 400 bed district general hospital over a four‐year period. Also included are some observations on a positive contribution to reduced length of stay for people with diabetes in hospital, and low incidences of prescription and management errors in the first National Diabetes Inpatient Audit in 2009.Specifically between 2005 and 2007 the average length of stay in days for all patients whose diagnosis included diabetes fell from 9.39 to 3.76 days despite the total number of patients increasing from 507 to 633 over the same quarter each year. The inpatient team provided almost 1000 visits to patients with diabetes in the first six months of each year 2008 and 2009, and at the first National Diabetes Inpatient Audit had only 5% prescription errors and 3% management errors (versus 19% and 14% respectively nationally) with 100% appropriate blood glucose testing.We suggest that a dedicated inpatient diabetes care team raises the quality of care for patients and enhances patient and professional education; we also suggest that audit standards should be developed for inpatient diabetes care and assessed in future national audits. Copyright © 2011 John Wiley & Sons.

Triple‐B (basal‐bolus‐booster) subcutaneous insulin regimen: a pragmatic approach to managing hospital inpatient hyperglycaemia

“…It is generally accepted that control of hyperglycaemia in hospitalised patients is important, although there remains some uncertainty about the target glucose level. For many health care providers, the more pressing question is how to achieve reasonable glycaemic control with limited resources, without major hyper‐ or hypoglycaemia 1–6. In the non‐critical care setting, even this modest aim is hampered by factors such as lack of standardisation of blood glucose level (BGL) monitoring and insulin regimens and rapid turnover of staff.…”

“…In the non‐critical care setting, even this modest aim is hampered by factors such as lack of standardisation of blood glucose level (BGL) monitoring and insulin regimens and rapid turnover of staff. Recent studies and American Diabetes Association guidelines have stated that scheduled BGL monitoring and insulin regimens with subcutaneous basal, nutritional and correctional components are preferred over sliding scale insulin (SSI) 5–10. Until 2008 in our hospital, as it would be in most institutions, SSI was the most common approach to manage non‐critically ill patients, with all of its inherent problems, including risk of poor glycaemic control and dangerous hypoglycaemia 6,9,10…”

Using the National Diabetes Inpatient Audit to evaluate the delivery of diabetes education

“…We proactively seek out and visit all patients with diabetes in the acute hospital on two morning ward rounds each week. Our work has been reported previously,4 as has an effective shortening of inpatient length of stay for all patients in the hospital with diabetes as a secondary diagnosis 5. Our philosophy of care has included the concept that every interaction of an HCP team member with a patient, or between HCPs, is an opportunity for education in a two‐way process – as well as delivering clinical care and establishing an effective therapeutic relationship with the patient, between team members, and with non‐specialist HCP colleagues.…”