For inpatients with diabetes and the skills to manage their disease, greater allowance of patient self-management may be reasonable, according to a recent British guideline.
“Hospital clinical staff should be aware that many people with diabetes in hospital wish to self-manage and should ensure this need is met as far as possible,” the document stated. Because of a lack of data, the guideline is based on the consensus view of the clinician-authors. The guideline was drafted by the Joint British Diabetes Societies for Inpatient Care group and was published June 19 by Diabetic Medicine.
People with diabetes have often been prevented from managing their disease while in the hospital, which has exposed them to mistakes in the administration of insulin, inappropriate content and timing of meals, mistreatment of hypoglycemia, and misuse of variable-rate intravenous insulin infusions, the guideline continued. Allowing patients with the appropriate skills to self-manage their condition is key to improving insulin safety in the hospital, according to the guideline. “Many people treated with insulin will have greater knowledge of their insulin regimen than the medical and nursing staff responsible for their care,” the guideline stated.
Specific advice included the following:
- 1. Written information should explain the responsibilities of self-management to people with diabetes and to hospital staff.
- 2. Staff and the patient should agree in writing on admission about the circumstances in which the person should self-manage.
- 3. For elective surgical admissions, a care plan should be agreed upon during the preoperative assessment to establish whether the patient wishes to self-manage and the circumstances in which this may not be possible.
- 4. During the hospitalization, clinical circumstances should be assessed regularly to ensure that the person's ability to self-manage has not been affected by his or her illness.
- 5. A diabetes specialist team should be involved if there is disagreement about the person's ability to self-manage or if there are difficulties with diabetes control.
- 6. People with diabetes should be able to self-monitor their blood glucose but should share results with hospital staff.
- 7. The insulin dose should be recorded on the prescription chart.
- 8. Timing and content of meals should be suitable for the person with diabetes.
- 9. Facilities should be available for the safe storage of insulin, or to warn patients of the consequences of such storage being unavailable.