NaDIA report shows medication errors have fallen

Medication errors and severe hypoglycaemia episodes have been reduced in hospital, according to the National Diabetes Inpatient Audit (NaDIA) 2019. 

The annual report has shown that severe hypoglycaemic episodes have been reduced from 12 per cent to seven per cent in 2019 and the need for injectable rescue treatment for severe hypoglycaemia has been lowered from 2.4 per cent of inpatients during the last seven days of their hospital stay in 2010 to 1.4 per cent in 2019.

The data published said that 75 per cent of those surveyed in 2019 were seen by the diabetes team where appropriate compared to only 54 per cent in 2010.

It is important to recognise the hard work of diabetes teams and the almost one hundred per cent participation in this annual audit, without which we may not have realised these improvements nor identified where we need to redouble our efforts Gerry Rayman, Clinical Lead for the National Diabetes Inpatient Audit

Inpatient diabetes teams have also reduced the proportion of inpatient drug charts found to contain medication errors by 15 percentage points since 2010 (from 45 to 30 per cent).

In addition, the number of people developing foot ulcers at any point during their hospital stay has gone down from 2.2 per cent of inpatients audited in 2010 to 1.1 per cent in 2019.

Life-threatening harms

However, the occurrence of some important and life-threatening harms remain unchanged, including severe hypoglycaemic episodes in inpatients with type 1 diabetes,  hospital-acquired diabetic ketoacidosis (DKA)  and hospital-acquired hyperosmolar hyperglycaemic state (HHS).

Gerry Rayman, Clinical Lead for the National Diabetes Inpatient Audit, Diabetes UK lead for Inpatient Diabetes, GIRFT Co-lead, said: “DKA and HHS are preventable and should not occur during a hospital admission. In this respect it is of interest that all medication errors have reduced with the exception of one, the failure to increase insulin when the capillary blood glucose1 (CBG) is persistently above 11 mmol/L, suggesting that focusing on staff training in hyperglycaemic management and insulin dose adjustment may reduce these life threatening harms.

“It is important to recognise the hard work of diabetes teams and the almost one hundred per cent participation in this annual audit, without which we may not have realised these improvements nor identified where we need to redouble our efforts. No other healthcare service in the world has such comprehensive national data to evidence and direct change in inpatient care; a unique achievement for which we should be proud.

NaDIA measures the quality of diabetes care provided to people with diabetes while they are admitted to hospital whatever the cause, and aims to support quality improvement. Data is collected and submitted by hospital staff in England.

Meanwhile, the 2019 National Diabetes Inpatient Audit (NaDIA) – Harms has also been published. The mandatory year-round collection of four harms that can occur to those with diabetes who are admitted to acute hospitals in England, captured data between May 2018 and October 2019.

All acute hospitals in England should take part in the audit to help reduce the rates of serious inpatient harms by informing their quality improvement work.

The report seeks to monitor the following complications:

  • Did the person require injectable rescue treatment for Hypoglycaemia (Hypo) more than six hours after admission?
  • Was the person diagnosed with new onset Diabetic KetoAcidosis (DKA) more than 24 hours after admission?
  • Was the person diagnosed with new onset Hyperglycaemic Hyperosmolar State (HHS) more than 24 hours after admission?
  • Was the person diagnosed with a new onset foot ulcer more than 72 hours after admissions.

A total of 2,905 Harms were submitted for this year’s report and using estimates derived from the 2019 NaDIA snapshot, case ascertainment in NaDIA-Harms ranges from six per cent (diabetic foot ulcer) to 20 per cent (DKA).

The majority of submitted harms were hypoglycaemic rescue with 2,055 recorded, followed by 440 incidents of DKA, 330 DFU and 80 HFU.

To read the NaDIA report in full, click here.

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