Inpatient care for children with diabetes: are standards being met?
- Julie Edge1,
- Frances M Ackland2,
- Susan Payne3,
- Antoinette McAuley3,
- Edward Hind4,
- Christine Burren5,
- Jan Burditt2,
- Debbie Sims6
- 1Department of Paediatric Endocrinology and Diabetes, Oxford Children's Hospital, Oxford, UK
- 2Department of Child Health, Northampton General Hospital, Northampton, UK
- 3Department of Paediatrics, Poole Hospital NHS Foundation Trust, Poole, UK
- 4Department of Paediatrics, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
- 5Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol, UK
- 6Department of Paediatrics, Royal Hampshire County Hospital, Dorchester, UK
- Correspondence to Julie Edge, Department of Paediatric Endocrinology and Diabetes, Oxford Children's Hospital, Oxford OX3 9DU, UK; julie.edge{at}paediatrics.ox.ac.uk
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Contributors JAE and FMA conceived the study. SP has been the audit administrator, designed and distributed the questionnaires and collated all the results. AM, JAE, EH and CB led the regional networks (one network has North and South leads) and involved all their clinical leads in contributing to the audit. JAE, FMA, SP, AM, EH, CB, JB and DS all helped to develop the audit, contributed to questionnaire design, helped with recruitment of centres and contributed to the writing and editing of the paper.
- Accepted 21 March 2012
- Published Online First 10 May 2012
Abstract
Background Hospital inpatient care is frequently mentioned by parents as unsatisfactory for children with diabetes. Ward staff are now less familiar with diabetes, as admissions are less common and diabetes management is more intensive.
Objective To compare current practice with Department of Health Children's Diabetes Working Group care standards.
Methods This audit surveyed the organisation of inpatient care for children with diabetes in three regional networks in southern England, and was funded by the Healthcare Quality Improvement Partnership.
Results All 27 services completed the questionnaire. Protocols for diabetic ketoacidosis, surgery, new diagnosis and hypoglycaemia were generally available on wards (70% had all four protocols) but less available in emergency departments (EDs) (52%). Trained children's nurses worked on every shift in children's wards (100%) but not necessarily in EDs (33%). Diabetes link nurses were identified on 74% of wards and 61% of high-dependency units (HDUs), and diabetes specialist nurses have inpatient liaison in their job description (89%) and working role (93%). Standards achieved less often were access to dietetic advice on wards (37%), education sessions for ED and ward staff, and informing diabetes team (only 26% within 2 h of admission during the day, and only 11% would contact the diabetes consultant overnight for a child admitted to a paediatric intensive care unit/HDU). Half of centres reported insulin errors.
Conclusions This first audit of children's diabetes inpatient care organisation demonstrates that some standards can be achieved, but others, such as having children's nurses on every shift in EDs, lack of dietetic advice to ward staff, and liaison with the diabetes team quickly out of hours, are more challenging. Further planned audit outcomes are to produce patient and parent literature for children admitted to hospital and to refine the standards further.
Footnotes
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Funding Healthcare Quality Improvement Partnership.
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Competing interests None.
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Provenance and peer review Not commissioned; externally peer reviewed.
