A report from the Health Services Safety Investigations Body finds that patients with diabetes who rely on insulin are experiencing persistent, serious safety risks when in hospital.
An investigation report from the Health Services Safety Investigations Body (HSSIB) highlights how patients with diabetes are facing such regular harms that some have died because their insulin-dependent conditions haven’t been appropriately managed in hospital.
Patients are also experiencing other kinds of serious safety risks, including their wearable diabetes technologies being removed during their time in hospital, and doctors more generally failing to effectively manage their conditions.
Insulin is a high-risk medication, well-established as among the most common causes of harm from medication errors in the NHS. But with diabetes prevalence rising across England, set to affect around 4.2 million people by 2030, the HSSIB is keen to reiterate the impact of these errors – and see a reduction in their numbers.
“Our investigation shows that, despite the dedication of hospital teams, patients with diabetes who rely on insulin still face persistent and avoidable risks when they come into hospital. When insulin management is disrupted – even briefly – the consequences can be serious, as we heard from patients and families who shared their distressing experiences of harm, to themselves or their loved ones,” warned senior safety investigator Craig Hadley.
“The investigation reveals a system under strain, creating difficult conditions that can hinder the safe administration of insulin for inpatients,” he continued.
He emphasised that as the prevalence of diabetes continues to rise, the wider health and care system must acknowledge the rising risks and their impact on people receiving hospital care.
Diabetes’ dangers
According to the report, patient deaths came about after insulin infusion was stopped before surgery, but not restarted, insulin was consistently administered after meals rather than before or was administered at too high a dose.
In addition, many patients aren’t consistently supported to self-administer insulin during their time as inpatients, even when they safely do so at home. This disruption to self-management routines can increase the likelihood of insulin being omitted, delayed or administered incorrectly.
For example, the investigation heard that approximately one-in-25 Type 1 diabetes patients in hospital enter diabetic ketoacidosis because their insulin is omitted or they aren’t given enough of it to deal with their clinical condition at the time.
The investigation also looked at how staff are supported to monitor and care for people with diabetes on wards, how patients are enabled to self-manage their insulin safely when appropriate and their progress against previous national recommendations.
As a result, the HSSIB has made various recommendations to bodies such as NHS England, the Department of Health and Social Care and the Royal College of Physicians. These include that they set out the expectations and responsibilities of NHS trusts and integrated care boards for the oversight and assurance of inpatient diabetes care, and act on new data and outcomes of studies about adopting blood glucose into NEWS2.
