re : Survey of the provision of inpatient diabetes services in UK Acute Trusts. Dear A reduction in the diabetes related bed occupancy on surgical /ortho wards …
re : Survey of the provision of inpatient diabetes services in UK Acute
Trusts
Dear
We are writing to ask for your help with an audit of inpatient diabetes
care in all UK Acute Trusts, which would take about 20 minutes to complete
This audit is funded by the Association of British Clinical Diabetologists
ABCD, and supported by the UK Diabetes Inpatients Specialist Nurse
DISN group
We all suffer from questionnaire fatigue but we hope this survey of all UK
Trusts will help clinical diabetes teams raise the profile of inpatient
diabetes care for all inpatients with diabetes The data will be useful in
discussions with Acute Trusts/PCTs in developing inpatient diabetes
services
It is a common experience that the inpatient care of patients with
diabetes is very variable - most patients are not managed by diabetes
teams Between 10 - 20 of adult inpatients in UK Acute Trusts have
diabetes in some age groups, and patient dissatisfaction with inpatient
diabetes care informed the NSF standard in this area
This survey is particularly interested in the provision of diabetes
services for diabetic
inpatients in the entire Trust, not just those under
the care of the diabetes specialist team In particular we are interested
in the role and use of Diabetes Inpatient Specialist Nurses in the UK -
there are now more than 100 such posts in the UK
All data in the questionnaire will be anonymised and absolutely
confidential, and only the summary data will be presented and published We
would be grateful for your help with this - this has been sent to the
Senior Diabetes Nurse and Diabetes Consultants in your Trust, and can be
returned in the attached sae
We would be very grateful if you could ensure this questionnaire escapes
the waste paper basket
Yours sincerely
Dr Mike Sampson Sister Esther Walden
Consultant Diabetologist Chair, UK DISN group
Contact details of individual completing this survey:
Name: ________________________________________________
Post: _______________________________________________
Direct Telephone no:_____________________________________
E mail:________________________________________________
Name of Acute Trust :____________________________________
Section 1 About
diabetes inpatient specialist nurses DISN
a Do you have a dedicated diabetes inpatient specialist nurse DISN
whose primary responsibility is the care of all inpatients with diabetes in
your Trust?
Yes No if no, proceed to Section 2 below
b When was this person s appointed? Please complete for each DISN
Month Year Grade
c How is this post currently funded?
PCTs Commissioning process
Acute Trust ie Trust endowments
Drug company
Departmental Endowments etc
Charitable funding
Other specify________________________________________________
d Is this posts whole time or part time?
Full time Part time, please specify hours per week __________
e Is recurrent funding for this post confirmed?
Yes No
f If no to e, when does funding expire?
Month Year
g Who in your organisation acts as the line manager for the DISN?
Consultant Diabetes Nurse Specialist
Service manager Other individual please state
____________________________________________________________
h Does the DISN undertake nurse prescribing for any of the following?
Insulin sliding scales s/c or iv Yes
No
Insulin regimens other than sliding scales Yes No
Insulin dose adjustments Yes No
Oral hypoglycaemics Yes No
i Does this DISN suggest changes to any of the following ?
Insulin sliding scales s/c or iv Yes No
Insulin regimens other than sliding scales Yes No
Insulin dose adjustments Yes No
Oral hypoglycaemics Yes No
j Does the DISN accept any of the following referrals?
Inpatient self referrals Yes No
Junior doctors Yes No
Consultants Yes No
Ward Nurses Yes No
Pharmacists Yes No
Physios/OTs Yes No
Podiatrists Yes No
If other - please state_________________________________________
k Can you estimate how the workload of your DISN is distributed each
month?
time spent
Direct patient contact
Teaching - groups
Teaching - individuals
Administrative letters / phone
l Can you estimate what the of the
DISN direct patient workload is each
month?
time spent
Patients with diabetic emergencies DKA/HONK/Hypos
Perioperative management of diabetes
Conversion to insulin regimen for inpatient inc education
Insulin dose adjustment
Education of inpatients
Other direct patient care
Are these figures an estimate or based on actual data
m Can you estimate what the of the DISN educational workload is each
week?
time spent
Group education of general ward nurses
Group education of inpatients
Supporting link nurse schemes
Education of junior medical staff
Are these figures an estimate or based on actual data
n When your DISN proposal was made to PCT/ Acute Trust /Commissioning
team, do you feel the success in attracting funding was based primarily on
any of the following :
Please rank 1 most powerful 6 least powerful
A reduction in the diabetes related bed occupancy on surgical /ortho wards
A reduction in the diabetes related bed occupancy on medical
Improvement in diabetes inpatient satisfaction
Qualitative improvement in diabetes care throughout
entire Acute Trust
Avoidance of litigation
Other reason, please state______________________________________
o Who provides internal cover for the DISN annual leave, study leave etc
Another DISN
Diabetes specialist Nurse TeamDNS
Paediatric Diabetes specialist nurse
Ward nurse
No one
p Does your DISN service cover any of the following areas?
Labour ward Yes No
Gynaecology wards Yes No
Paediatric wards Yes No
ITU Yes No
A/E Yes No
CCU Yes No
Section 2 Only complete this section if you do not have a dedicated DISN
with primary responsibility for the inpatient management of all diabetic
inpatients in your Trust :
a Do the Diabetes Specialist Nurses routinely contribute to the inpatient
management of diabetes inpatients not just those under the care of a
Diabetologist as part of their job plan ?
Yes No
b If yes to 2a above, how many hours or WTE per week are devoted by the
DNS team to this service ?
hours
c If no to 2a above, do the DNS team see inpatients with diabetes, not
under the care of a Diabetologist, at the request of other
medical and
surgical teams?
Yes No
d Do you feel a DISN would improve the management and quality of care of
all inpatients in your Trust, not under the care of the Diabetes team?
Yes No
e Have you ever had a business case for a DISN rejected?
Yes No
f As a Diabetes team, and from a clinical perspective, do you feel a DISN
would be most clinically useful for your team to help you to :
Please rank 1 most to 9 least useful
Reduce diabetes excess bed occupancy on surgical /orthopaedic wards
Reduce diabetes excess bed occupancy on medical / geriatric wards
Qualitative improvement in diabetes care on surgical/orthopaedic wards
Qualitative improvement in diabetes care on medical / geriatric wards
Management of DKA and hypoglycaemia admissions
Reduction of DNS workload
Avoidance of litigation
Improvement in diabetes inpatient satisfaction
Other , please state____________________________________________
h Would you be interested in seeing/sharing successful business cases from
other Acute Trusts?
Yes No
Section 3 Diabetes inpatient services : activity data analysis
a What is the population of the district served by your Acute Trust ?
Please write
figure in boxes
b How many people with known diabetes are there in this population?
Please write figure in boxes
c How may WTE diabetes nurse specialists are there in your service?
Please write figure in boxes
d What is the activity per annum of direct inpatient contacts by the
DISN ?
Please write figure in boxes
e If you do not have a DISN , what is the activity per annum of direct
inpatient contacts by the Diabetes Specialist Nurses?
Please write figure in boxes
Please note the following questions only apply if this data is already
available and to hand for the last financial year
f Do you know the number of inpatients with a discharge diagnosis of
diabetes in your Trust in the last financial year 1404 - 30305?
Financial year Data not available
g Do you know the percentage of inpatients with a discharge diagnosis of
diabetes in your Trust in the last financial year 1404 - 30305?
Financial year Data not available
h Do you know the number of occupied bed days incurred by people with
diabetes in your Trust in the last financial year 1404 - 30305, as
an absolute value or as a percentage of total?
Total bed days
Data not available
Percentage bed days Data not available
i Do you know the median length of inpatient stay for diabetes patients in
your Trust in relation to non - diabetes patients?
Diabetes patients Data not available
Non- Diabetes patients Data not available
j If the answer to h is no - would your Trusts IT team be willing and
able to produce this data if requested?
Yes No
k Do you know the excess bed days for diabetes patients in your Trust
compared to those without diabetes in the last financial year ?
Diabetes patients Data not available
l Do you know what the rate is for under recording of diabetes as a
discharge diagnosis is in your Trust ?
Yes No
If yes, what is the rate?
m Does your Trust Chief Executive know that 10 - 20 of inpatient bed
days in the Trust are incurred by diabetic patients, and that much of this
is avoidable excess
Yes No
Section 4 Protocols and guidelines and patient perspective
a Does your Trusts Diabetes team support the use of subcutaneous
sliding scale insulin regimens for all inpatient s with diabetes?
Yes No
b Does your Trust have inpatient
guidelines for the following areas?
DIGAMI 1 protocol YesNo
Blood glucose monitoring policy YesNo
Dealing with hypoglycaemia YesNo
Management of ketoacidosis YesNo Immediate
Management of the diabetic foot YesNo Perioperative
management for patients requiring insulin YesNo
Perioperative management for patients not requiring insulin YesNo
Barium studies in patients requiring insulin YesNo
Upper GI endoscopy in patients requiring insulin YesNo
Colonoscopy in patients requiring insulin YesNo
If 0ther - please state
c Have the negative outcomes from DIGAMI 2 influenced your use of the
DIGAMI 1 protocol?
Yes No
d Would you be interested in sharing these protocols / guidelines on the
UK DISN website put this in here with other teams?
Yes No
e Do you have a questionnaire for formally surveying your patients views
on inpatient diabetes services?
Yes No
f Do you use any measure of inpatient diabetes treatment satisfaction
through questionnaire or formal survey ?
Yes No
g Have you personally
been involved in litigation or a coroners case
associated specifically with standards of inpatient diabetes management in
your Trust within the last 12 months, excluding patients under the care
of a diabetes specialist team?
Yes No If yes, how many__________________________
h When admitted, are the following patients automatically referred to,
or triaged to, the Diabetes specialist team on the day of admission
Diabetic ketoacidosis YesNo
Acute severe hypoglycaemia YesNo
Hyperosmolar non - ketotic coma YesNo
Infected neuropathic foot ulceration YesNo
Newly diagnosed Type 1 diabetes YesNo
_____________________________________________________________
Any comments on inpatient diabetes management specific or general for
patient not managed by the specialist diabetes team ?
______________________________________________________________
Thank you very much for completing this Please note that all data analysis
and presentation will be encrypted and entirely anonymised, without any
personal identifiers, and presented only
in summary form
Please return in enclosed sae to :
Christine Jones, DISN Administrator,
Elsie Bertram Diabetes Centre,
Norfolk and Norwich University Hospital NHS Trust,
Norwich, NR4 7UY Tel: 01603 288206
