We visited six hospitals in England in September and October 2007 to identify best practice in the care of inpatients with a secondary diagnosis of diabetes and explore with them what can be done to share this best practice across the wider NHS. We held a stakeholder event in early September 2007 to explore this area with frontline clinical staff in terms of both the challenges and solutions to improving inpatient care for people with diabetes. We held a co production event in early December 2007 to share and validate our early findings from our visits, and to begin to develop prototype tools that might help organisations improve the inpatient care they provide for people with diabetes.

Focus On: Inpatient care for people with diabetes 

The ‘Focus On: Inpatient care for people with diabetes’ report was published in March 2008 and provided details of the issues involved, the benefits that could be achieved by changes in working practices and a high level view as to the changes required.

This good practice guide tells you about the NHS Institute’s wider diabetes project and explores in detail the seven key characteristics needed to achieve high-quality inpatient diabetes care.

These are:

Patient experience

Clear focus on the patient.

Early identification

Fail-safe system for early identification of people with existing diabetes and with hypo/hyperglycaemia.


Early comprehensive and standardised assessment of the patient’s relevant diabetes needs.

Care pathway

Jointly agreed and effectively implemented care pathway.

Inpatient specialist team

Effective use of inpatient specialist diabetes team.

Staff education

Appropriate training using adult learning modules.

Commissioning and planning

Good communication between diabetes specialist team, hospital management and commissioners.


Since then the toolkit has been designed and tested in collaboration with NHS organisations to improve elements of the patient’s pathway. These elements link with the key characteristics described in the ‘Focus on Inpatient care for patients with diabetes’ document.

Testing took place in four NHS organisations between October 2008 and January 2009. and was conducted according to NHS Institute’s methodology of rapid testing. Outcomes have been beneficial for the patients at the test sites but also for the clinical teams involved as described here:

Being involved with ThinkGlucose has meant that I have had the opportunity to be very involved in the education of staff at ward level. The discussions we have had, has given me insider knowledge of their perspective

Clinical audit are often seen as the police to be kept to one side. They are invigorating to work with, The different personalities, skills and approaches strengthen our MDT. Clinical audit will help to provide evidence to inform the working practices.
Clinical Auditor

A group of professionals working together tend to choose those tasks where they are most comfortable working. As such, a MDT is less likely to duplicate effort compared to a group of DSNs. When we all come back together, we decide who is going to do what next. We are able to enthuse each other and spur each other on.
Clinical Nurse Specialist



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