Study reports diabetes harm in hospitals

Serious medication and diabetes management errors leading to harm in hospitals were more than twice as common in diabetes patients receiving insulin than in those taking oral blood glucose lowering medication, major new research of diabetes care in hospitals has revealed.

Queensland Inpatient Diabetes Survey (QuIDS) 2019 found high rates of medication error, hospital-acquired harm such as hypoglycaemia and diabetic ketoacidosis, and suboptimal rates of appropriate glycaemic control particularly in patients treated with insulin.

The cross-sectional bedside audit captured management of diabetes in 850 patients from medical, surgical, mental health, high dependency or intensive care wards across 27 public hospitals in Queensland.

The audit found medication errors in 32% of patients including both prescription errors (19%) and management errors (19%). Errors were more than twice as common in patients receiving insulin than in patients receiving oral hypoglycaemic agents.

There were also low rates of achieving glycaemic targets with 59 good diabetes days per 100 patient-days.

Surgery and diabetes

Hypoglycaemic episodes – either moderate (74%) or severe (26%) – were identified in 9.5% of patients and diabetic ketoacidosis was identified in 8% of patients with type 1 diabetes.

The study, published in The MJA,  found 29% of patients who underwent surgery during their admission had a clearly documented perioperative diabetes management plan.

“The deficiencies in practice we found exist despite a standard insulin prescription and blood glucose monitoring form and statewide digital prescribing and glucose monitoring; both systems are linked with point-of-care decision support that provides evidence-based advice about safe prescribing of basal-bolus insulin for hospitalised patients,” the study said.

Specialist teams to reduce diabetes harm in hospitals

The researchers, led by Dr Peter Donovan from the Royal Brisbane and Women’s Hospital, told the limbic, an online publication for endocrine healthcare professionals, that 14% of patients met the criteria for specialist team care but were not seen by any diabetes specialists either medical, nursing or allied health.

“To improve inpatient diabetes care in Queensland, expanding the availability of specialist diabetes teams should be considered,” they said.

Dr Donovan, a staff specialist in internal medicine and clinical pharmacology, said that the study was the first step towards improving how patients with diabetes were managed.

“We knew that there was a problem but no-one had actually documented the particular areas of diabetes management that needed to be focussed on.”

“It wasn’t really a surprise what we found and the results are consistent with what are being found in England and Wales and in the National Diabetes Inpatient Audit.”

Management of diabetes care in hospitals

Diabetes Queensland CEO Sturt Eastwood told the Courier Mail that the most common complaint reported to the organisation from people living with diabetes regards the management of their diabetes after they’re admitted to hospital.

“We have presented these concerns to government and we will continue to work with them while they investigate these issues,” Mr Eastwood said.

“We need to ensure that when a person with diabetes is admitted to a Queensland hospital, their diabetes is treated as a priority, regardless of the reason for their admission.

“Diabetes is complex and underlies other conditions, such as heart and kidney disease. While many hospitalisations for people with diabetes are not for the treatment of diabetes, their diabetes needs to be treated as a priority.

“We know that having diabetes extends the length of time people spend in hospital. It is vital that diabetes is part of the equation when people living with diabetes are admitted. That is not always the situation currently.”

Queensland Health said it was working with partner agencies such as Diabetes Queensland to further support people in the management of their diabetes and reducing harm in hospitals.

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