Aims: We sought to audit our practice with the primary aim of improving diabetes service provision to our outpatients. Secondary Aims included developing a teaching document for junior doctors in OPD.
Methodology: A retrospective audit of patient charts from monthly diabetes clinics from August to November inclusive examining our adherence to ISPAD Clinical Practice Consensus Guidelines 2014 as endorsed by BSPED.
Findings: We audited 38 charts, 45% female and 55% male patients. Average age on day of visit was 11 years, 4 months. 79% of patients had undergone review 4 times in the preceeding year. 16% of HbA1c results were within target range, 61% were suboptimal. 24% were in the high risk range. 100% of patients had their height & weight recorded. 71% of height and 74% of weight measurements were plotted on appropriate growth charts. BMI was recorded in 74% of our patients, with an average of 19.14 kg/m2. The BMI percentile was recorded in 47%. 80% of patients had appropriately undergone retinopathy screening in the past year. 21.4% of patients were inappropriately screened for retinopathy. 100% of our patients were appropriately screened for nephropathy at point of care. 88.9% of patients were inappropriately screened. 100% of appropriate patients were screened for hypertension. No BP percentiles were recorded. 46% of other patients inappropriately screened. 78% of appropriate patients had lipid screening in the preceeding year. 82% of patients had appropriate TSH screening at diagnosis; 15% had TPO antibody testing recorded. 95% of patients were screened for Primary Adrenal Insufficiency in the preceeding year via U&E, in absence of specific guidance. 82% of patients had rotation of injection sites & needle size recorded. 71% had injecting sites examined. No patients were screened for vitamin D deficiency. 37% had a discussion regarding physical activity. Patients were seen on average 2.7 times per year by the dieticican.
Recommendations: A case was made for increasing diabetes dietician staffing levels. A new plan for OPD visits to include an annual assessment was proposed along with the development of a written aid for NCHDs with a view to re-auditing our adherence to the guidelines.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes