Department of Paediatric Endocrinology and Diabetes, Oxford Children's Hospital, Oxford OX3 9DU, UK.
Arch Dis Child. 2012 Jul;97(7):599-603. doi: 10.1136/archdischild-2011-301212. Epub 2012 May 10.
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.
To compare current practice with Department of Health Children's Diabetes Working Group care standards.
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.
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.
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.
医院住院治疗经常被患儿家长认为不满意。由于住院人数减少，糖尿病管理更加集中，病房工作人员对糖尿病的了解也较少。
比较当前实践与英国南部三个区域网络的卫生署儿童糖尿病工作组护理标准。
该审计调查了英格兰南部三个区域网络中儿童糖尿病住院患者护理的组织情况，由医疗保健质量改进伙伴关系资助。
所有 27 家服务机构均完成了问卷调查。糖尿病酮症酸中毒、手术、新诊断和低血糖的方案通常在病房（70%有所有四个方案）中提供，但在急诊部（52%）中较少提供。儿童病房每个班次都有经过培训的儿童护士（100%），但不一定在急诊部（33%）。74%的病房和 61%的高依赖单位（HDU）有糖尿病联络护士，糖尿病专科护士的工作描述（89%）和工作角色（93%）中都有住院联络。较难达到的标准包括病房获得饮食建议（37%）、ED 和病房工作人员的教育课程以及通知糖尿病团队（仅在白天入院后 2 小时内通知 26%，夜间只有 11%会联系糖尿病顾问，为入住儿科重症监护病房/HDU 的儿童）。一半的中心报告胰岛素错误。
这是首次对儿童糖尿病住院治疗组织情况进行的审计，表明一些标准可以达到，但其他标准，如在 ED 每个班次都有儿童护士、病房工作人员缺乏饮食建议以及夜间与糖尿病团队的快速联络，更具挑战性。进一步计划的审计结果是为住院儿童编写患者和家长文献，并进一步完善标准。
