Setting

This audit was conducted in a tertiary specialist secure hospital, and will be particularly relevant in forensic secure and rehabilitation services with long-stay psychiatric in-patients.

Background

People with severe mental illness are at an increased risk of physical health problems and often find it hard to access good-quality care. Patients with schizophrenia in particular have an increased prevalence of type II diabetes compared with the general population.

Standards

Audit standards were based on the 2008 guideline from the National Institute for Health and Clinical Excellence (NICE) for the management of type II diabetes (see also NHS Diabetes, 2009). Key priorities within the guideline were identified and adapted to suit a psychiatric in-patient setting. Of particular relevance were:

1. ▸ structured patient education at the time of diagnosis, with annual reinforcement and review

2. ▸ individualised and ongoing dietary advice from a healthcare professional with specific expertise and competencies in nutrition

3. ▸ setting a target HbA1c (generally 6.5%) –

4. ⊲ involve the patient in the decision and give encouragement to maintain individual targets

5. ⊲ offer therapy interventions (lifestyle and medication) to help achieve and maintain target

6. ⊲ monitor every 2–6 months according to individual needs until stable on unchanging therapy, and every 6 months once the blood glucose level and blood glucose-lowering therapy are stable

7. ▸ self-monitoring to be offered where possible

8. ▸ management of acute changes in plasma glucose control.

The target was for these standards to be met for every patient with diabetes in the form of an individual care plan.

Method

Data collection

The hospital on-site general practice register or physical healthcare register or prescription charts were used to identify patients with type II diabetes. Data collection was from patient records, care plans, hospital-wide risk assessment and management documents, and ward documents, including nursing care plans, drug prescription charts and blood results. Other sources of information included informal interviews with nursing staff and information obtained from medical staff.

Data analysis

The proportion of patients with diabetes for whom the standards were met was calculated.

Resources required

People

Two people were required to conduct this audit in an in-patient service with 548 beds. Some additional assistance was required from nursing staff and other medical colleagues.