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24-05-2012 | Legal medicine | Article

Medication errors rife in UK diabetes inpatients

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MedWire News: Many hospitals across England and Wales are under-resourced for diabetes care, reveals a national audit report.

The 2011 National Diabetes Inpatient Audit suggests that considerably more needs to be done if the safety and care of people with diabetes in hospital is to be assured.

During a 7-day audit period in October 2011, almost a third of 3700 inpatients who received treatment for their diabetes experienced at least one medication error. And patients who had a medication error were more than twice as likely to have a severe hypoglycemic episode compared with those who did not.

In addition, 65 (0.6%) patients developed diabetic ketoacidosis while in hospital, an increase of 0.2% on the number recorded in 2010.

The audit assessed bedside data and questionnaires regarding the clinical care of 12,806 patients, representing 136 National Health Service trusts in England and six health boards in Wales. Data were collected on the characteristics of each hospital including staffing structures, patients' clinical information and medical needs, and patient experience.

The report showed that the medication errors fell into two main groups: prescription mistakes and medication-management inaccuracies.

The most common prescription error was failing to sign off on the patient's bedside information chart that insulin had been administered, which happened in 11.1% of cases. This compared with 12.7% of patients experiencing this error in 2010.

The most frequent medication-management error was failing to adjust medication when patients had hyperglycemia, which happened to 23.9% of patients, an improvement on the previous year's 27.9%.

The audit also showed that 69.1% and 55.6% of sites in England and Wales, respectively, had no specialist inpatient dietetic provision for diabetic individuals while 30.9% and 22.2%, respectively, had no inpatient podiatry service.

"Although it is pleasing to see there have been improvements in medication errors since the last audit there is a long way to go and indeed the majority of hospital doctors and ward nurses still do not have basic training in insulin management and glucose control," said lead auditor Gerry Raman from Ipswich Hospital in Suffolk, UK, in a press statement.

"Training needs to be mandatory to improve diabetes control and reduce the frequency of severe hypoglycemia. 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."

Big improvements can happen by adequately staffing hospitals with inpatient diabetes specialist teams, who can provide leadership, governance, and training to other hospital staff, concluded Raman.

By Sally Robertson

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