Nearly one in three hospital patients with diabetes are affected by medication mistakes that can lead to dangerously high or low blood glucose levels, checks have revealed. Hospitals in England and Wales made at least one error in the treatment of 3,700 people with diabetes during just one week, according to an audit covering nearly 13,000 patients at 230 hospitals. This represented a small improvement on previous figures for England alone, but Diabetes UK, the main charity in the field, said the overall picture was an “indictment” on NHS care for those with the condition.
Its chief executive, Barbara Young, said: “The fact that there are so many mistakes, and that for some people a stay in hospital means they get worse, should simply not be happening.
“Poor blood glucose management, caused by errors in hospital treatment, is leading to severe and dangerous consequences for too many people. For example, there are a number of recorded episodes of diabetic ketoacidosis, the result of extremely high blood glucose levels caused by a lack of insulin.”
The audit was managed by the NHS’s Health and Social Care Information Centre and Diabetes UK and commissioned by the Healthcare Quality Improvement Partnership, a body led by medical and nursing royal colleges and National Voices, formerly the Long-term Conditions Alliance.
Patients with medication errors suffered more than double the number of severe hypoglycaemic – “hypo” – episodes than patients without errors. These happen when blood glucose levels drop dangerously low and, if left untreated, can lead to seizures, coma or death.
In addition, 68 patients developed diabetic ketoacidosis (DKA) during their stay in hospital. DKA occurs when blood glucose levels are consistently high, which suggests that insulin treatment was not administered for a significant period. DKA can be fatal if not treated.
During the week of the checks, 68 patients had developed DKA, a potentially life-threatening condition, after admission to hospital. The audit also revealed that hospitals did not have enough staff expert in diabetes, especially those who understood the importance of foot care. About 100 people with diabetes undergo leg, foot or toe amputations each week in England, many of which could be prevented, according to Diabetes UK. Foot ulcers are also common.
Two-thirds of the patients included in the audit were admitted to hospital for reasons other than their diabetes. They tended to be older than other inpatients.
Gerry Rayman, a consultant physician and head of service at Ipswich Hospital Trust’s diabetes and endocrine centre, who was clinical lead for the audit, said there was a long way to go for diabetes care. Most hospital doctors and ward nurses still did not have basic training in insulin management and glucose control, he said.
“Training needs to be mandatory to improve diabetes control and reduce the frequency of severe hypoglycaemia. It is also needed to prevent diabetic ketosis occurring in hospital, for which there can be no excuse; its occurrence is negligent and should never happen.”
Rayman said controlling diabetes could be difficult in some patients, more so if they were ill and unable to eat and drink. “This is why the knowledge, experience and skills of diabetes specialist staff are so important. There is no doubt that big improvements in care and patient safety can happen by ensuring hospitals are adequately staffed with inpatient diabetes specialist teams, who can provide leadership, governance and training to other hospital staff.”
The audit took place last autumn. The first was conducted in 2010 in England only.