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50% drop in rate of hospital-acquired foot ulcers, audit shows

Little improvement on other patient harms and lack of specialist staff

Adrian O'Dowd

Monday, 27 June 2016

Only 1.1% of inpatients with diabetes developed a new foot lesion during their admission to hospital in 2015 – halving from the 2.2% rate when inpatient auditing began in 2010.

The new figures come from the National Diabetes Inpatient Audit (NaDIA), carried out by the Health and Social Care Information Centre, in collaboration with Diabetes UK, published today.

However, since 2010, similar improvements in the other two main hospital inpatient harms - severe hypoglycaemic episodes and the severe life-threatening and wholly preventable condition diabetic ketoacidosis (DKA) - have not occurred.

The audit was carried out by diabetes teams in acute hospitals in 135 trusts in England and six local health boards in Wales on a nominated day in September. It covers issues such as staffing levels, medication errors, patient harm and patient experience. The 2015 audit surveyed 15,299 patients with diabetes.

It found that more than two thirds (67%) of inpatients included in the 2015 audit did not have a specific diabetic foot risk examination during their hospital stay and less than a third (31%) of hospital sites did not have a multi-disciplinary diabetic foot care team.

The inspection teams found that the proportion of inpatients having one or more hypoglycaemic episodes since 2010, has reduced from 26.1% to 21.8%.

However, there has been no significant reduction in the proportion of inpatients having one or more severe life-threatening hypoglycaemic episodes that required emergency rescue with injectable treatment (2.4% in 2010 compared to 2.1% 2015).

Since the audit began in 2010, there has been also been no reduction in the proportion of inpatients developing DKA after admission - 0.4% in both 2010 and 2015.

Numbers of hospital beds occupied by people with diabetes has risen each year from 14.6% in 2010 to 16.8% in the 2015 audit, while 83.7% of sites reported an increase in referrals/patient contacts since the 2013 NaDIA.

Despite growing demand, there has been no corresponding significant increase in staffing levels, as the audit showed that almost a third of sites (31.1%) had no diabetes inpatient specialist nurse available – the same as in 2010 – and consultant access was also limited with 9.2% of sites not having any consultant time for diabetes inpatient care.

There was also a slight increase in numbers of inpatients experiencing medication errors – increasing from 37% to 38.8% since the previous audit in 2013.

Audit lead clinician, Dr Gerry Rayman, a consultant physician and head of service at the diabetes and endocrine centre at Ipswich Hospital NHS Trust, said: “We are proud of what the audit has achieved since 2010 and the difference it has made to hospital care for patients with diabetes.

“However the results do show that, while the number of inpatients continues to rise, this is not being matched by resources and staffing which could make an even more significant improvement.”

Chris Askew, chief executive of Diabetes UK, said: “We welcome the audit report and the improvements to hospital care for patients with diabetes since it began in 2010 but there is still much cause for concern.

“Currently one in three hospitals does not have a single diabetes specialist nurse, and almost 40% of people with diabetes, who may or may not be in hospital because of their diabetes, are nonetheless experiencing medication errors.”

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