In-patient care for children with type 1 diabetes across hospitals in the Yorkshire and Humber region in the north of England

Abstract

Objectives: Identify variations in in-patient care provided to children with type 1 diabetes across the Yorkshire and Humber region, with a view to standardisation of care. Method(s): The audit was conducted against in-patient care standards identified by the Children and Young Persons Diabetes Implementation Support Group (CYPDISG). Questionnaires were sent to clinical leads of all paediatric diabetes units in the region, which serves a total of 2599 children and young people with diabetes. Result(s): Fifty-six per cent of the units, consisting of 2 tertiary and 7 secondary care units, responded. All units had paediatric nurses in areas where children were cared for, but only the tertiary centres had a trained paediatric nurse in the emergency department (ED) on every shift. Paediatric wards and EDs in all units had protocols for management of new diagnosis of diabetes, diabetic ketoacidosis (DKA), hypoglycaemia and surgery. All units had regular education sessions for ward staff, although 22% expressed concerns regarding poor attendance and only 22% of units had education sessions for ED staff. A 24 hour on-call service was only provided by 22% of the units.The diabetes team was usually contacted within 2 hours of an admission in tertiary centres and within 24 hours in secondary care units.Paediatric diabetes specialist nurses had an active role in inpatient management in all units. Only 2 units had insulin prescription charts and only tertiary centres routinely audited insulin prescription and administration errors. Conclusion(s): There is a lack of 24 hour on-call service in majority of the paediatric diabetes units. Standardisation of on-call services and feasibility of implementation of the same needs to be explored. ED staff should be involved in education sessions and strategies to improve attendance need to be considered. Further work is needed to standardise in-patient care for children and young people with type 1 diabetes across the region and nationally.