Sunday, 4 May 2014

7 Day Diabetes Service




Diabetes patients in Portsmouth had good news this week as the diabetes department has finally been given the green light to have a 7 day service. What will this look like on paper? How exactly will this be done? At the moment I don’t know, but what I do know is that patient safely will be improved, therefore improving the overall quality of the patient experience.

Reflecting back over past experiences of inpatient care I would say that they have been… variable. I have, unfortunately, suffered from DKA (Diabetic Ketoacidosis – A dangerous and potentially life threatening complication) in the past, despite my best efforts to fend it off, resulting in hospital admissions. Some experiences of inpatient care have been smooth and some less so. Of late, as more and more people are using insulin pumps to manage their diabetes, I’ve heard people talking about fear and uncertainty over hospital admissions, not only from patient's but also hospital staff.

In the media recently, the case of Gillian Astbury has come to light and has highlighted the unacceptable standards of basic care in Stafford Hospital that resulted in Gillian’s unnecessary death. For those who don’t know, Gillian died at the age of 66 in 2007 due to nursing staff failing to administer her insulin. Gillian went into a coma as a result of prolonged high blood glucose levels and sadly passed away.

How Gillian must have felt being so poorly with such high blood sugars makes me feel incredibly sad. As someone who’s suffered from DKA I can relate in some way to the terribly uncomfortable, sometimes painful, feeling that it brings, the unquenchable thirst that is sustained by not being able to keep fluids down, and the utter exhaustion the patient feels as their body is drained from energy, leaving them wanting to do nothing but sleep.

What makes me feel even sadder when I think about Gillian is how quickly a patient can feel better when they are given the correct care for their diabetes. Insulin – that is what’s needed when a person’s blood glucose level is high – and it astounds me that, for whatever reason (though there is NO acceptable reason), insulin wasn't given to Gillian. When I’ve been in hospital with high blood glucose levels before it’s almost as if I can feel minute by minute the affect that insulin is having, and at that time there is no better feeling in the world as relief washes through you.  

As I mentioned above, my care has been variable. Two examples that stand out to me are; being admitted to hospital and being attached to a sliding scale that was delivering a large amount of insulin, whilst still being connected to my insulin pump, resulting in my blood glucose levels dropping dangerously low. It wasn’t until my diabetes team arrived on Monday morning that anything was done. The second example was being refused a sliding scale on admission, resulting in me being in DKA for 12 hours until, again, my diabetes consultant arrived the next morning. Note that my diabetes team played an integral part in my care improving.

These experiences started my involvement in advocating for 24/7 care and 7 day services. 

Firstly I addressed the issues, face-to-face, when I was asked at the Portsmouth Type 1 Diabetes Conference (The Sweet Meet) what I wanted from my diabetes team.

“Patient safety for all diabetes inpatient's and a 7 day service.”

I couldn’t even articulate what this service would look like because at the time I was still incredibly frustrated at what I’d experienced.

The next step was to make some more contacts. NHS IQ (NHS Improving Quality) were my first port of call and I was invited to a 7 day service conference in which I was given the opportunity to talk about my experiences to a room full of Health Care Professionals, Commissioners, patients and also Sir Robert Francis’ team. It didn’t stop there – I gathered information from other Trusts about how they were delivering a 7 day service in some departments and passed it to providers at my hospital.

Next up was to address the issue with those who would play an essential part in improving patient safety. I wrote to the CEO of my hospital, the chief of medicine, the heads of the departments where I was admitted and my diabetes team. They each had copies of my experience and soon enough I received a long and positive reply from the CEO. Perhaps I should have gone through the system and gone to PALS, but Diabetic Ketoacidosis can kill in a matter of hours – Do we always have time to go through the system?

And finally… This week, over twitter, I heard the news that Portsmouth Hospital Diabetes team have been given the thumbs up to have a 7 day service. I know that a lot of hard work must have gone into this service becoming a reality and I know the hard work won’t end there as the DSN’s deliver it. As awful as my experiences were, I was lucky enough to get through them and maybe help in some way towards this service. However, it’s a sad fact that it came to patient safety being compromised to make this happen, and that patient’s need to go through so many different channels just to feel safe and to be cared for in an appropriate way. It’s also an incredibly sad fact that, in the case of Gillian, it took someone losing their life for diabetes to be respected.


RIP Gillian x    





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