The inpatient diabetes team at University Hospital Southampton NHS Foundation Trust recently launched D1abasics, an initiative that aims to improve inpatient care for people with diabetes. In this blog, Diabetes Consultant Mayank Patel and Inpatient Diabetes Specialist Nurse Paula Johnston outline the approach and explain how it will equip staff across all specialties with the basic knowledge to care safely for people with diabetes in hospital.
Nearly one in five inpatients in UK hospitals has diabetes. Where we work at University Hospital Southampton, we have 1200 inpatient beds, meaning that over 200 of our patients have diabetes at any point in time. As the prevalence of diabetes increases across the population, that figure is expected to rise to one in three over the next few years. When people with diabetes are admitted to hospital, more often than not, it is for reasons other than diabetes—recent data suggests that at least 90% of patients are in hospital for reasons other than their diabetes. Although not all forms of diabetes require complex additional intervention, diabetes management is often thrown out of sync by a hospital stay. For this reason, it’s vital that healthcare professionals in all specialties understand the basics of managing diabetes, including the differences between type 1, type 2 and other forms of diabetes.
Worryingly, research shows us that this isn’t the case—the most recent Diabetes Getting It Right First Time (GIRFT) national report highlights nationwide failures in monitoring patients with diabetes, a high prevalence of insulin errors and a high rate of diabetic ketoacidosis in patients with type 1 diabetes. The report indicates a widespread lack of knowledge across healthcare professionals about the fundamentals of caring for inpatients with diabetes. Our own experience as a diabetes inpatient team bears this out; we come across many doctors, nurses and other professionals who aren't aware of the most basic principles of diabetes management, or who lack confidence to apply their knowledge safely.
A solution to help staff understand the basics of inpatient diabetes care
As a team, we realised the situation was giving us an unsustainable workload and putting patients at risk. We often receive calls from junior doctors who are not familiar with the most basic principles of diabetes care, and from wards asking us to visit patients for simple blood sugar management decisions that could be taken by anyone with the right knowledge, often by using our existing app-based guidelines. These requests take our attention from those patients with diabetes with the highest level of need who require our specialist support. We needed to do something to make sure all inpatients with diabetes are cared for safely, whichever ward or specialty they end up in, so we came up with a plan.
With project management support and funding from Diabetes UK, we developed the D1abasics campaign, which aims to make sure every person working in the hospital understands the basics of diabetes care. We have produced banners, lanyards and other resources to provide quick reference points for staff while they are providing care for a person with diabetes. D1abasics is an acronym that covers different aspects of care including identifying patients with diabetes, listening to their concerns and views, understanding the importance of blood glucose monitoring and timely insulin administration in patients with type 1, and recognising the impact of other medical conditions, medications and treatments on diabetes control. You can access these resources at the bottom of this page.
We have also visited every ward in the hospital to talk about D1abasics and explain what we’re trying to achieve. It’s really important that new staff are on board from the beginning of their time at the hospital, so we’re embedding D1abasics training in the induction process—in July, we will be seeking to reach up to 500 new starters about the initiative, via a recorded ‘introduction to diabetes in hospital’ video, as part of their hospital induction.
Diabetes has an image problem which results in a reluctance among some healthcare professionals to get involved in aspects of diabetes care, as it seems complex and unpredictable. One of the aims of D1abasics is to demystify diabetes and increase people’s confidence that they can provide safe care. Part of this is helping people understand when they can do it themselves, and when they need to ask for our help—there will of course be times when we need to offer specialist care to patients whose diabetes is not responding to standard interventions, or who have complex medical situations. Our hope is that D1abasics will free up our time to focus on those patients that really need our input.
Engaging staff and patients in the process
While we were developing D1abasics, we spoke to staff about what would most help them and tried to understand the elements of diabetes care that were causing patient safety issues.
We also asked patients for feedback, which was really helpful as they helped us see areas where slightly changing the language would make our messages clearer. The patients we spoke to were very grateful for the initiative, as going into hospital can be worrying for people with diabetes.
Measuring impact and rolling D1abasics out to other hospitals
We’re very hopeful that D1abasics will make a tangible difference to the safety of people with diabetes staying in our hospital. Over the next few months, we’ll speak to ward managers and other staff to get their feedback on the difference the resources and training are making. We’ll also be keeping tabs on the quality of referrals we receive and the number and nature of incident reports involving patients with diabetes.
The issues we have identified are not confined to Southampton, they are present in every hospital trust in the country. Since launching D1abasics, we’ve had a lot of interest from people working at other organisations, and we are keen that other hospitals use the resources. We left our hospital logo off our materials on purpose—we don’t ‘own’ the initiative and if it can be used and adapted to improve care and outcomes for people with diabetes, we’re all for it!
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- Improving safety for diabetic inpatients: 4 key steps (Partha Kar)
- “I felt lucky to get out alive”: why we must improve hospital safety for people with diabetes
1 Dhatariya K, Mustafa O, Rayman G. Safe care for people with diabetes in hospital. Clin Med, 15 January 2020
2 Rayman G, Kar P. Diabetes: GIRFT Programme National Specialty Report. NHS, November 2020
About the Author
Dr Mayank Patel has worked as a Consultant in Diabetes and Acute Medicine at University Hospital Southampton in 2008. He is a fulltime clinician, and his main clinical roles are in delivering inpatient diabetes care, diabetic foot clinics, diabetes renal clinics and leading the insulin pump service. He is also an Honorary Senior Clinical Lecturer at the University of Southampton.