Diabetes UK: Shorthand and bad writing are potential errors in treating people with diabetes

Monday, 1 March 2010 12:00 AM

People with diabetes are at risk of serious harm due to errors through inappropriate abbreviations and illegible writing on their prescription charts, according to findings presented this week at Diabetes UK's Annual Professional Conference in Liverpool.

Researchers from the Royal Liverpool University Hospital looked at 75 charts of people with diabetes and found that in 5 per cent of cases, the use of doctors' own abbreviations and hastily written notes could easily be misread by the nursing staff. The audit also reveals that one in six (17.3 per cent) charts had prescription errors. The majority of these were illegible, a few were not dated and some were not signed by the prescribing doctors. Medication must only be given if the prescription is signed by a doctor, which means there was delay in the administration of insulin. In addition, one in three charts did not have the correct timings for insulin injections.

For people with diabetes who treat their condition with insulin (all people with Type 1 diabetes and around 30 per cent of people with Type 2 diabetes), their daily insulin regime is vital to good diabetes management. Too little insulin could lead to coma, which can occur when blood glucose levels are high (hyperglycaemia) and can cause nausea, vomiting, stomach pain, rapid breathing and, if left untreated, may lead to death. Too much insulin could cause a hypoglycaemic episode (hypo) where the blood glucose levels go too low, resulting in symptoms ranging from sweating to a loss of consciousness.

Simon O'Neill, Director of Care, Information and Advocacy at leading health charity Diabetes UK, said: "Diabetes UK is extremely concerned at this audit's startling revelations. Correct insulin doses and the timely co-ordination of medication and meals are basic, but essential factors for good diabetes management and improved health. At least ten per cent of people in hospital have diabetes. Although not all people with diabetes treat their condition with insulin, the potential health risks to tens of thousands of people can be avoided with simple measures.

"Hospitals should ensure that specialist diabetes teams are available to assure competences of non-diabetes staff and provide appropriate support to ensure that people with diabetes in hospital are able to access the high quality care they should expect."

Dr Nagaraj Malipatil, lead researcher at the Royal Liverpool University Hospital, said: "Insulin prescribing, has for a long time been subject to less scrutiny and is prescribed less diligently because it is such a common medication in hospitals. Our audit has demonstrated an unacceptably high percentage of errors.

"A misunderstanding from an abbreviation for insulin units could have serious if not fatal consequences. For example, a doctor should prescribe insulin as "10 units" at a specified time, if written as "10 I U" or

"10 I units", this could be easily misread as 101 units with lethal complications.

"There are guidelines and medicines policies on writing correct prescriptions. It is this strict adherence to the medicines policy that forms the basis to reduce the incidence of potential errors in patients' treatment. Doctors must avoid the use of abbreviations for insulin units and all hospitals need to ensure that correct insulin prescribing is covered in junior doctor training as part of their risk management strategy.

"We undertook a re-audit after intensive training of junior doctors and members of the team have shown significant reduction in prescription errors."

The research has been shortlisted for the Diabetes UK Education Award at the conference.

There are currently 2.6 million people diagnosed with diabetes in the UK, of which 250,000 have Type 1 diabetes.

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For further media information, please contact Maria Lam or Rupi Gohlar in the Diabetes UK Media Relations Team on 020 7424 1165 or emailpressteam@diabetes.org.uk.

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Notes to editor:

1 An audit on reducing inappropriate abbreviations and insulin prescribing errors. NS Malipatil, M Handi and PJ Weston. Department of Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool.

2 The Diabetes UK Annual Professional Conference (APC) is taking place from 3 to 5 March 2010 at the Arena and Convention Centre (ACC) in Liverpool. It is the UK's largest diabetes conference with over 3,000 healthcare professionals attending.

3 Diabetes UK is the leading charity for the three million people in the UK with diabetes. We aim to spend more than ¿6.5 million on research in 2010 as well as campaigning and providing information and support. For more information visit www.diabetes.org.uk

4 In the UK, there are currently 2.6 million people diagnosed with diabetes and it is estimated that up to half a million people have Type 2 diabetes but do not know it.

5 The Diabetes UK Careline (0845 120 2960) offers information and support on any aspect of managing diabetes. The line is a low cost number and opens Monday to Friday between 9am and 5pm (operates a translation service). Recorded information on a number of diabetes-related topics is also available on this number 24 hours a day.

6 Supporting our work to fund vital research into the care, treatment and hopefully a cure for diabetes as a Diabetes UK Supporting Member entitles you to a range of benefits including our bi-monthly magazine Balance, reliable information booklets on diabetes, our confidential Diabetes UK Careline, over 400 local Diabetes UK support groups, and access to an exclusive personalized Supporting Members Area on our website.

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