The Rowan Hillson Inpatient Safety Award 2019 for the best perioperative pathway for people with diabetes

Abstract

Introduction: The annual National Diabetes Inpatient Audit (NaDIA) in the UK continues to show a high incidence of insulin errors in patients admitted to hospital with diabetes. New initiatives are urgently required to mitigate this risk.

Method: The Joint British Diabetes Societies for Inpatient Care (JBDS-IP) organised the sixth national Rowan Hillson Inpatient Safety Award on the theme of the best perioperative pathway for people with diabetes.

Result: The winner was the team from Aneurin Bevan University Health Board led by Dr David Burckett-St Laurent for their innovative re-design of the perioperative pathway by a cross-specialty working group. The main elements of the new system were standardised patient assessment, optimisation of perioperative diabetes control, personalised diabetes management plans generated from a drop-down menu with information on usual drug treatment, pre-op/day of surgery diabetes medication modification, advice on hypoglycaemia management and sick-day rules, anaesthetic review for people with HbA1c >69 mmol/mol, secondary care diabetes review for people with suboptimal diabetes control, new inpatient charts with guidance on diabetes drug management, streamlining of time and place of admission and greater engagement and education of people with diabetes and staff looking after them. This resulted in significant improvement in outcomes and reduction in risks.

The Newcastle upon Tyne NHS Foundation Trust team led by Dr Nicola Leech and colleagues received the runners-up award for their 3-year quality improvement project involving multiple specialties. The project included development of trust-wide policies and protocols, educational initiatives, targeted diabetes specialist nurse in-reach, innovative electronic whiteboard alerts for glycaemic control and electronic hypo alerts. The result was a reduction in insulin errors and hypoglycaemia on surgical wards by over 50%, a reduction in Datix incidents and fewer patients suffering harm events.

Summary and conclusion: These and similar schemes need to be developed, promoted and shared to reduce insulin errors in hospitalised patients with diabetes.