Ward staffing levels significantly affect timing of insulin administration in hospital

Introduction
Patients with diabetes mellitus may constitute up to 16% of patients at any one time in hospital.1 Many of these patients are taking insulin therapy and require nursing supervision or help with administration. Previous studies have demonstrated that lower numbers of hospital nursing staff have been shown to lead to an increased incidence of pneumonia, bed sores and overall poorer outcome for hospitalised patients.2,3

We prospectively studied the impact of nurse staffing levels in a diabetes specialist ward and the effect this had on the timing of prescribed insulin therapy.

Methods
We included all patients who were admitted to a diabetes specialist ward in our Trust who required insulin nurse supervision or nurse administration from 1 February to 30 April 2009 inclusive. Well staffed (WS) days were defined as days where there was a full complement of nursing staff with an on‐site nurse coordinator. Low staffed (LS) days were defined as days where nursing staff levels were 75% or less of a full complement and without a nurse coordinator. Insulin was considered delayed if it was administered more than 30 minutes later than the prescribed time. Nurses on the ward were given a questionnaire to fill in at the end of their shift in order to state the time insulin had been administered. Information regarding staff attendance was obtained from the human resources department and the ward off‐duty record.

All blood glucose concentrations in the diabetes specialist inpatient unit were measured on a glucose analyser and the results transmitted via the intranet to the pathology department. The required data were then downloaded from diagnostic glucose software. Audit approval was obtained prior to the commencement of the study.

Results
There were a total of 59 patients over the three‐month study period who fulfilled the criterion for analysis. The median age of the patients was 68 (interquartile range 59–76); 26 females and 33 males. The results are summarised in Table 1.