Diabetes (DIA) Measures Document

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1 Diabetes (DIA) Measures Document DIA Version: covering patients discharged between 01/07/2016 and present. Programme Lead: Liz Kanwar Clinical Lead: Dr Aftab Ahmad Number of Measures In Clinical Focus Area (CFA) Clinical Process Measures 10 advancing.quality@nhs.net Website: Produced on 21 June 2016

2 Introduction Diabetes is a metabolic condition associated with insulin insufficiency (Type I) and resistance (Type II), resulting in an inability to regulate blood glucose levels. When diabetes is not well managed (where the blood glucose level becomes too low or too high), it is associated with serious complications including heart disease, stroke, blindness, kidney disease, nerve damage and amputations leading to disability and premature mortality. Since 1996, the number of people with diabetes in the UK has risen from 1.4 million to 2.9 million, which is now estimated to rise to 5 million by Diabetes is currently the fifth most common reason for death in the world and is the most common cause of lower limb amputation, accounting for about half of all cases. Tragically, up to 70% of those who lose a lower limb as a result of their diabetes die within 5 years. Patients are admitted to hospital with a range of diabetes complications but, can also develop complications of diabetes during their hospital stay. The Advancing Quality Diabetes measures have been chosen to prompt early recognition and treatment of patients; both those admitted to hospital with diabetes complications or those patients who develop complications of diabetes during their hospital stay. The expected outcomes are to reduce premature mortality and a long term reduction in non-traumatic amputations. Only patients with a primary diagnosis of diabetes on a hospital episode are included in the Advancing Quality population. Patients with diabetes recorded as a comorbidity are not included in the population. Page 2

3 Measures In Clinical Focus Area Measure Type Measure ID Clinical Process Measure DIAB-01 DIAB-02 HYPO-01 HYPO-02 DKA-01 DKA-02 DKA-03 FOOT-02 FOOT-04 FOOT-05 Measure Name Blood Glucose within 30 minutes of hospital arrival Foot inspection within 24 hours of hospital arrival Quick acting carbohydrates administered within 15 min of hypoglycaemia detection Blood Glucose monitored after carbohydrate administration NEWS and GCS within 60 min of DKA detection Bloods repeated at least once within 4 hours of detection IV Fluids and Fixed Rate Insulin commenced within 60 minutes of DKA detection Antibiotic administered within 6 hours of foot ulcer detection Seen by hospital foot care team within 96 hours of detection Outpatient appointment booked within 6 weeks of discharge Page 3

4 Measure ID: Measure Name: DIAB-01 Blood Glucose within 30 minutes of hospital arrival Unique Record Identifier: Measure Description: Blood capillary glucose levels are tested within 30 minutes of hospital arrival Measure Type: Clinical Process Measure Rationale: Blood capillary glucose is a quick and effective method to assess the patient s blood glucose levels to allow identification of normal or abnormal (high and low) blood glucose levels which will inform the clinical diagnosis and treatment plan. All diabetic patients presenting to hospital should have their blood glucose checked on arrival regardless of the reason for presentation, e.g. even patients presenting with a fracture should be tested if they are diabetic. Numerator Statement: The number of patients who have blood capillary glucose levels tested within 30 minutes of hospital arrival. Denominator Statement: The number of eligible patients who are required to have blood capillary glucose levels tested within 30 minutes of hospital arrival. Measure Reported As: The percentage of patients who have blood capillary glucose levels testing within 30 minutes. Improvement Noted As: An increase in the rate. Notes: This measure applies to all patients in the population regardless whether they are admitted for diabetes complications or develop one while in hospital. Time zero for all patients is hospital arrival. Evidence of blood glucose testing prior to arrival is not sufficient to pass this measure. A negative time will fail the measure. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Arrival Date Arrival Time Blood Glucose Date Arrival Blood Glucose Time Arrival Page 4

5 Measure ID: Measure Name: DIAB-02 Foot inspection within 24 hours of hospital arrival Unique Record Identifier: Measure Description: Foot inspection within 24 hours of arrival Measure Type: Clinical Process Measure Rationale: Foot inspection (simple visual examination) of both feet is an essential part of management of people with diabetes. This is to allow early identification of any foot ulcer or pre-ulcer risk factors such as increased pressure areas and cuts and will inform the treatment plan. One of the complications associated with diabetes is peripheral vascular disease (damage caused to large blood vessels supplying lower limbs) causing poor circulation and loss of sensation in the feet, which can lead to foot ulcer development. Numerator Statement: The number of patients that have a foot inspection within 24 hours of hospital arrival. Denominator Statement: The number of eligible patients that are required to have a foot inspection within 24 hours of hospital arrival. Measure Reported As: The percentage of patients who have a foot inspection within 24 hours of hospital arrival. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Double Foot Amputee Foot inspection - within 24 hours Measure Exclusions: The patient is a double foot amputee Page 5

6 Measure ID: Measure Name: HYPO-01 Unique Record Identifier: Measure Description: Quick acting carbohydrates administered within 15 min of hypoglycaemia detection Quick acting carbohydrates are administered within 15 minutes of hypoglycaemia detection. Measure Type: Clinical Process Measure Rationale: People experiencing hypoglycaemia require quick acting carbohydrate to return their blood glucose levels to the normal range. The quick acting carbohydrate should be followed up by giving long acting carbohydrate either as a snack or as part of a planned meal. All patients experiencing hypoglycaemia should be treated without delay. Numerator Statement: The number of patients who have quick acting carbohydrates administered within 15 minutes of hypoglycaemia detection. Denominator Statement: The number of eligible patients who are required to have quick acting carbohydrates administered within 15 minutes of hypoglycaemia detection. Measure Reported As: The percentage of patients who receive quick acting carbohydrates within 15 minutes of hypoglycaemia detection. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Diabetic coding Hypo Resolved Before Arrival QAC Administered QAC in 15 minutes Measure Exclusions: Hypoglycaemia resolved before arrival at hospital Page 6

7 Measure ID: Measure Name: HYPO-02 Blood Glucose monitored after carbohydrate administration Unique Record Identifier: Measure Description: Following quick acting carbohydrate administration, blood capillary glucose should be monitored 15 minutes after carbohydrate administration. Measure Type: Clinical Process Measure Rationale: The Diabetes UK Guideline 'Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus' recommends that patients are given 15-20g quick acting carbohydrate of the patient s choice where possible. This is followed by repeat capillary blood glucose measurement minutes later. Numerator Statement: Following quick acting carbohydrate administration, the number of patients who have blood glucose monitoring following quick acting carbohydrate administration at 15 minutes after carbohydrate administration. Denominator Statement: Following quick acting carbohydrate administration, the number of eligible patients who are required to have blood glucose at 15 minutes after carbohydrate administration. Measure Reported As: The percentage of patients who have blood glucose monitoring following carbohydrate administration. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Diabetic coding Blood Glucose Monitored Hypo Resolved Before Arrival QAC Administered Measure Exclusions: Hypoglycaemia resolved before arrival at hospital Page 7

8 Measure ID: Measure Name: DKA-01 NEWS and GCS within 60 min of DKA detection Unique Record Identifier: Measure Description: National Early Warning Score (NEWS) and Glasgow Coma Scale (GCS) carried out within 60 minutes of DKA detection. Measure Type: Clinical Process Measure Rationale: The monitoring of National Early Warning Score (NEWS) and Glasgow Coma Scale (GCS) allows early identification of the patient s survival risk factors and the treatment required. Numerator Statement: The number of patients who have received Early Warning Score and Glasgow Coma Scale within 60 min of DKA detection. Denominator Statement: The number of eligible patients required to have Early Warning Score and Glasgow Coma Scale within 60 min of DKA detection. Measure Reported As: The percentage of patients who have NEWS and GCS within 60 minutes of DKA detection. Improvement Noted As: An increase in the rate. Notes: Alternative methods of standardised Early Warning Scores are Medical Early Warning Score (MEWS) OR National Early Warning Score (NEWS) Alternative method of Glasgow Coma Scale (GCS) is Alert, Verbal, Pain and Unresponsive (AVPU) scale Data Elements: To be considered complete the following data elements should be recorded for the measure:- Diabetic coding GCS within 60 minutes NEWS or GCS Reason NEWS within 60 minutes Measure Exclusions: There was a valid clinical reason for not recording NEWS/GCS for the patient Page 8

9 Measure ID: Measure Name: DKA-02 Bloods repeated at least once within 4 hours of detection Unique Record Identifier: Measure Description: Patients with diabetes ketoacidosis are required to have blood tests carried out initially and then repeated within 4 hours of DKA detection. Two tests are required to pass this measure: Urea and Electrolytes (U&E's) AND Serum bicarbonate via venous blood gases (or Arterial blood gases) Measure Type: Clinical Process Measure Rationale: The monitoring of blood tests allows early identification of the patient s biochemistry and the treatment required. Early repeated monitoring will track the progress/deterioration in relation to the detected DKA, thus supporting the continued treatment plan to prevent mortality. Numerator Statement: The number of patients who have repeated blood tests within 4 hours of DKA detection. Denominator Statement: The number of eligible patients to have repeated blood tests within 4 hours of DKA detection. Measure Reported As: The percentage of patients who have repeated blood tests within 4 hours of DKA detection. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Diabetic coding Bloods - reason Bloods - repeated Measure Exclusions: There was a valid clinical reason for not performing blood tests Page 9

10 Measure ID: DKA-03 Measure Name: IV Fluids and Fixed Rate Insulin commenced within 60 minutes of DKA detection Unique Record Identifier: Measure Description: Intravenous (IV) Fluids and Fixed Rate Insulin should be commenced within 60 minutes of DKA detection Measure Type: Clinical Process Measure Rationale: Intravenous (IV) fluids are an essential treatment for DKA patients to restore fluid and electrolyte balance preventing dehydration, subsequent organ failure and mortality. Fixed rate intravenous (IV) Insulin is an essential treatment for DKA patients to restore a normal blood glucose level preventing subsequent coma and mortality. Numerator Statement: The number of patients who have IV Fluids and Fixed Rate Insulin commenced within 60 minutes of DKA detection. Denominator Statement: The number of eligible patients who are required to have IV Fluids and Fixed Rate Insulin commenced within 60 minutes of DKA detection. Measure Reported As: The percentage of patients who have IV Fluids and Fixed Rate Insulin within 60 minutes of DKA detection. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Diabetic coding Fixed Rate Insulin in 60 min Fixed Rate IV Insulin - already on IV Fluids - already on IV fluids within 60 minutes Measure Exclusions: The patient was already on both IV fluids and Fixed Rate Insulin Page 10

11 Measure ID: Measure Name: FOOT-02 Antibiotic administered within 6 hours of foot ulcer detection Unique Record Identifier: Measure Description: Antibiotic administered within six hours of the foot ulcer being detected. Measure Type: Clinical Process Measure Rationale: Early initiation of antibiotic therapy in patients with non-healing or progressive ulcers, with clinical signs of active infection (redness, pain, swelling or discharge), leads to ulcer healing and prevention of complications of infection such as gangrene and sepsis; thus preventing mortality. Numerator Statement: The number of patients that have antibiotics administered within six hours of the foot ulcer being detected. Denominator Statement: The number of eligible patients that are required to have antibiotics administered within six hours of the foot ulcer being detected. Measure Reported As: The percentage of patients who have an antibiotic administered within six hours of the foot ulcer detection. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Antibiotics - reasons Antibiotics - within 6 hours Double Foot Amputee Foot Ulcer Detected Measure Exclusions: The patient is a double foot amputee There was no foot ulcer detected There was a valid clinical reason for not administering antibiotics Page 11

12 Measure ID: Measure Name: FOOT-04 Seen by hospital foot care team within 96 hours of detection Unique Record Identifier: Measure Description: Patient seen by hospital foot care Multi Disciplinary Team (MDT) within 96 hours of detection. Measure Type: Clinical Process Measure Rationale: Diabetic foot problems can deteriorate very quickly leading to foot amputations, these can be prevented by early detection, referral and treatment. There is evidence that hospital foot care MDTs are effective at preventing diabetic amputations. NICE recommend that "a foot problem requiring urgent medical attention" is referred and treated within 24 hours of detection. A foot problem requiring urgent medical attention is defined as a new ulceration a new swelling or a new discolouration. Recognising that seven day working is not yet fully implemented across all providers, this measure aims to ensure all patients with a foot ulcer detected are seen by the hospital MDT foot care team within 72 hours of the referral. NG advises referral "within 1 working day to the multidisciplinary foot care service or foot protection service...for triage within 1 further working day." This has been extended to 96 hours to allow for weekends. The measure will be kept under review with a possible move to a shortening of the timeframe. Numerator Statement: The number of patients who have been seen by the hospital foot care MDT within 96 hours of detection. Denominator Statement: The number of eligible patients who are required to be seen by the hospital foot care MDT within 96 hours of detection. Measure Reported As: The percentage of patients seen by hospital foot care MDT within 96 hours of detection. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Double Foot Amputee Foot Care Team - reason Foot Care Team - Seen Date Foot Care Team - Seen Time Foot Ulcer Detected Foot Ulcer Detected Date Foot Ulcer Detected Time Measure Exclusions: The patient is a double foot amputee There was no foot ulcer detected There was a valid reason for not being seen by the hospital foot care MDT Page 12

13 Measure ID: Measure Name: FOOT-05 Outpatient appointment booked within 6 weeks of discharge Unique Record Identifier: Measure Description: There is evidence in the medical record that an outpatient appointment, with the appropriate specialist team, was booked and that the appointment date is within 6 weeks of the date of discharge. Measure Type: Clinical Process Measure Rationale: Patients are required to have discharge planning, which should include making arrangements for the patient to be assessed and their care managed in primary and/or community care, and followed up as an outpatient by specialist teams. An outpatient appointment booked with the appropriate specialist team ensures that any deterioration is quickly identified and the relevant management plan can be put in place, thus preventing amputation. The appropriate specialist team may be any member of the following staff group who has specialist training and expertise in diabetic foot wounds and lower limb complications (refer to the Diabetes UK 2006 Minimum Skills Framework): Consultant diabetologist Podiatrist/podiatric surgeon or both Diabetes specialist nurses (including a diabetes specialist inpatient nurse) Ward link nurses Orthotist Consultant vascular surgeon Consultant orthopaedic surgeon Consultant microbiologist Consultant in pain management (with an interest in diabetic neuropathy) Consultant radiologist Numerator Statement: The number of patients who have an outpatient appointment booked with an appropriate specialist team for within 6 weeks of discharge. Denominator Statement: The number of eligible patients who are required to have an outpatient appointment booked with an appropriate specialist team for within 6 weeks of discharge. Measure Reported As: The percentage of patients who have an outpatient appointment booked with an appropriate specialist team for within 6 weeks of discharge. Improvement Noted As: An increase in the rate. Data Elements: To be considered complete the following data elements should be recorded for the measure:- Double Foot Amputee Foot Ulcer Detected OP Appointment - in 6 weeks OP Appointment - reason Measure Exclusions: The patient is a double foot amputee There was no foot ulcer detected There is a valid reason documented for not booking an Outpatient Appointment Page 13

14 Appendices I. Data Elements Required for Clinical Focus Area Data Element Definition Source Collected for Measures Antibiotics - reasons Antibiotics - within 6 hours Arrival Date Arrival Time Blood Glucose Date Arrival Blood Glucose Monitored Blood Glucose Time Arrival Bloods - reason Bloods - repeated Diabetic coding There is a reason documented for not administering antibiotics. Antibiotics were administered within 6 hours of the foot ulcer being detected. The earliest documented date (dd/mm/yyyy) that the patient arrived at the hospital for this spell of care/treatment. The earliest documented time (hh:mm) (24 hour clock) the patient arrived at the hospital. The date (dd/mm/yyyy) of the blood glucose test taken on arrival at the hospital. Blood Glucose was monitored within 15 minutes of Quick acting carbohydrates being administered The time (hh:mm) of the blood glucose date take on arrival at hospital There was a valid reason for not repeating blood tests within 4 hours of DKA detection. The required blood tests were repeated at least once within 4 hours of DKA detection. The clinical coding of the patients diabetic episode generated by the SUS data. Double Foot Amputee It is documented in the medical record that the patient was a double foot amputee. Fixed Rate Insulin in 60 min Fixed Rate IV Insulin - already on Foot Care Team - reason Foot Care Team - Seen Date Foot Care Team - Seen Time Foot inspection - within 24 hours Foot Ulcer Detected There is documentation that the patient was commenced on fixed rate intravenous (IV) insulin within 60 minutes of the Diabetic Ketoacidosis (DKA) being detected. There is documentation that the patient was already on fixed rate insulin when the Diabetic Ketoacidosis (DKA) was detected. Documentation in the medical record by the consultant (or person working as part of the consultant team) that the patient should not be seen by the hospital foot care MDT. The date (dd/mm/yyyy) the patient was seen by the hospital foot care MDT. The time (hh:mm) the patient was seen by the hospital foot care MDT. There is documentation in the medical record that a foot inspection was done within 24 hours of hospital arrival. There was evidence of a foot ulcer on arrival or at any time during the inpatient stay. i.e. even if there is no evidence of a foot ulcer on the day of admission but there is documentation later in the Hospital data collection Hospital data collection SuS FOOT-02 FOOT-02 DIAB-01 DIAB-01 DIAB-01 HYPO-02 DIAB-01 DKA-02 DKA-02 DKA-01, DKA-02, DKA-03, HYPO-01, HYPO-02 DIAB-02, FOOT-02, FOOT-04, FOOT-05 DKA-03 DKA-03 FOOT-04 FOOT-04 FOOT-04 DIAB-02 FOOT-02, FOOT-04, FOOT-05 Page 14

15 Foot Ulcer Detected Date Foot Ulcer Detected Time GCS within 60 minutes Hypo Resolved Before Arrival stay, then select 'Yes' to this question. The earliest date (dd/mm/yyyy) the foot ulcer was detected. If there is more than one instance of foot ulcer recorded in the medical record then the earliest reference must be used. The earliest time (hh:mm) (24 hour clock) the foot ulcer was detected. If there is more than one instance of foot ulcer mentioned in the medical record then the earliest reference must be used. The patient had a GCS score recorded within 60 minutes of DKA detection. The patient was hypoglycaemic, but received treatment before arrival at hospital and the hypoglycaemia was resolved (blood glucose measured at >= 4mmol/l). Therefore, the patient did not require additional treatment for their hypoglycaemia while in hospital. IV Fluids - already on There is documentation that the patient was already on Intravenous (IV) fluids when the Diabetic Ketoacidosis (DKA) was detected. IV fluids within 60 minutes There is documentation that the patient was put on IV fluids within 60 minutes of the Diabetic Ketoacidosis (DKA) being detected. NEWS or GCS Reason There was a reason recorded in patient notes for not recording a NEWS or GCS. If there is a valid clinical reason for not recording either of the measures, or the patient refuses, select "No" for this question. NEWS within 60 minutes OP Appointment - in 6 weeks OP Appointment - reason QAC Administered QAC in 15 minutes The patient had a NEWS recorded within 60 minutes of DKA detection. There is documentation in the medical record that an outpatient appointment, with the appropriate specialist team, was booked and that the appointment date is within 6 weeks of the date of discharge. There is documentation within the medical notes that there was a valid reason for the patient not to have had an outpatient appointment booked to be seen within six weeks from discharge for their foot ulcer The patient was given quick acting carbohydrates (QAC) following the hypoglycaemia detection. The patient was given quick acting carbohydrates within 15 minutes of hypoglycaemia detection. FOOT-04 FOOT-04 DKA-01 HYPO-01, HYPO-02 DKA-03 DKA-03 DKA-01 DKA-01 FOOT-05 FOOT-05 HYPO-01, HYPO-02 HYPO-01 Page 15

16 II. Population Identification Criteria with Codes There are four categories (sub-populations) of AQ Diabetes patients. The patients are segmented into Hypoglycaemia, Diabetic Ketoacidosis (DKA) and Other Diabetes. Any of these patients can also be in the Foot Ulcer sub-population. An automated routine will use the following parameters to identify the AQ Diabetes population from the routinely available Admitted Patient Care / Payment by Results dataset. Emergency admissions. 18 years of age and over. DKA - includes any episode where: the primary ICD-10 code is in the DKA Group. Hypoglycaemia - includes any episode where: the primary ICD-10 code is in the Hypoglycaemia Group AND a secondary diagnosis code is in the Other Diabetes Group; OR the primary ICD-10 code is in the Other Diabetes Group AND a secondary diagnosis code is in the Hypoglycaemia Group. Other Diabetes - includes any episode where: the primary ICD-10 code is in the Other Diabetes Group AND no secondary ICD-10 code is in the Hypoglycaemia Group. Foot Ulcer the foot ulcer sub-population will not be identified using ICD-10 diagnosis coding as this will not reliably confirm the target population. Instead a qualifying question will be asked in the AQ data collection and patients with a confirmed foot ulcer will be eligible for the FOOT Measures. EMERGENCY ADMISSION METHODS 21 - A&E 22 - GP 23 - Bed bureau 24 - Consultant Clinic 28 - Other Means 2A - Accident and Emergency Department of another provider where the PATIENT had not been admitted 2D - Other emergency admission LISTS OF ICD10 CODES FOR DIABETES HYPOGLYCAEMIA GROUP E160 - DRUG-INDUCED HYPOGLYCAEMIA WITHOUT COMA E161 - OTHER HYPOGLYCAEMIA E162 - HYPOGLYCAEMIA, UNSPECIFIED DKA GROUP E101 - INSULIN-DEPENDENT DIABETES MELLITUS WITH KETOACIDOSIS E111 - NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH KETOACIDOSIS E121 - MALNUTRITION-RELATED DIABETES MELLITUS WITH KETOACIDOSIS E131 - OTHER SPECIFIED DIABETES MELLITUS WITH KETOACIDOSIS E141 - UNSPECIFIED DIABETES MELLITUS WITH KETOACIDOSIS Page 16

17 OTHER DIABETES GROUP E100 - INSULIN-DEPENDENT DIABETES MELLITUS WITH COMA E102 - INSULIN-DEPENDENT DIABETES MELLITUS WITH RENAL COMPLICATIONS E103 - INSULIN-DEPENDENT DIABETES MELLITUS WITH OPHTHALMIC COMPS E104 - INSULIN-DEPENDENT DIABETES MELLITUS WITH NEUROLOGICAL COMPS E105 - INSULIN-DEPENDENT DIABETES MELLITUS WITH PERIPH CIRC COMPS E106 - INSULIN-DEPENDENT DIABETES MELLITUS WITH OTHER SPEC COMPS E107 - INSULIN-DEPENDENT DIABETES MELLITUS WITH MULTIPLE COMPS E108 - INSULIN-DEPENDENT DIABETES MELLITUS WITH UNSPEC COMPS E109 - INSULIN-DEPENDENT DIABETES MELLITUS WITHOUT COMPLICATIONS E10X - INSULIN-DEPENDENT DIABETES MELLITUS E110 - NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH COMA E112 - NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH RENAL COMPS E113 - NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH OPHTHALM COMPS E114 - NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH NEURO COMPS E115 - NON-INSULIN-DEPEND DIABETES MELLITUS WITH PERIPH CIRC COMP E116 - NON-INSULIN-DEPEND DIABETES MELLITUS WITH OTHER SPEC COMP E117 - NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH MULTIPLE COMPS E118 - NON-INSULIN-DEPENDENT DIABETES MELLITUS WITH UNSPEC COMPS E119 - NON-INSULIN-DEPEND DIABETES MELLITUS WITHOUT COMPLICATION E11X - NON-INSULIN-DEPENDENT DIABETES MELLITUS E120 - MALNUTRITION-RELATED DIABETES MELLITUS WITH COMA E122 - MALNUTRITION-RELATED DIABETES MELLITUS WITH RENAL COMPS E123 - MALNUTRITION-RELATED DIABETES MELLITUS WITH OPHTHALMIC COMPS E124 - MALNUTRITION-RELATED DIABETES MELLITUS WITH NEURO COMPS E125 - MALNUTRITION-RELAT DIABETES MELLITUS WITH PERIPH CIRC COMP E126 - MALNUTRITION-RELAT DIABETES MELLITUS WITH OTHER SPEC COMPS E127 - MALNUTRITION-RELATED DIABETES MELLITUS WITH MULTIPLE COMPS E128 - MALNUTRITION-RELATED DIABETES MELLITUS WITH UNSPEC COMPS E129 - MALNUTRITION-RELATED DIABETES MELLITUS WITHOUT COMPLICATIONS E12X - MALNUTRITION-RELATED DIABETES MELLITUS E130 - OTHER SPECIFIED DIABETES MELLITUS WITH COMA E132 - OTHER SPECIFIED DIABETES MELLITUS WITH RENAL COMPLICATIONS E133 - OTHER SPECIFIED DIABETES MELLITUS WITH OPHTHALMIC COMPS E134 - OTHER SPECIFIED DIABETES MELLITUS WITH NEUROLOGICAL COMPS E135 - OTHER SPECIFIED DIABETES MELLITUS WITH PERIPH CIRC COMPS E136 - OTHER SPECIFIED DIABETES MELLITUS WITH OTHER SPEC COMPS E137 - OTHER SPECIFIED DIABETES MELLITUS WITH MULTIPLE COMPS E138 - OTHER SPECIFIED DIABETES MELLITUS WITH UNSPECIFIED COMPS E139 - OTHER SPECIFIED DIABETES MELLITUS WITHOUT COMPLICATIONS E13X - OTHER SPECIFIED DIABETES MELLITUS E140 - UNSPECIFIED DIABETES MELLITUS WITH COMA E142 - UNSPECIFIED DIABETES MELLITUS WITH RENAL COMPLICATIONS E143 - UNSPECIFIED DIABETES MELLITUS WITH OPHTHALMIC COMPLICATIONS E144 - UNSPECIFIED DIABETES MELLITUS WITH NEUROLOGICAL COMPS E145 - UNSPECIFIED DIABETES MELLITUS WITH PERIPH CIRCULATORY COMPS E146 - UNSPECIFIED DIABETES MELLITUS WITH OTHER SPECIFIED COMPS E147 - UNSPECIFIED DIABETES MELLITUS WITH MULTIPLE COMPLICATIONS E148 - UNSPECIFIED DIABETES MELLITUS WITH UNSPECIFIED COMPLICATIONS E149 - UNSPECIFIED DIABETES MELLITUS WITHOUT COMPLICATIONS E14X - UNSPECIFIED DIABETES MELLITUS Page 17

18 IV. Algorithms Page 18

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28 Diabetes: Advancing Quality Data form Name: Hospital Number: DOB: / / NHS: Ethnicity: ALL PATIENTS 1. Arrival date & time / / : 2. Blood glucose test on arrival / / : 3. Did the patient have both feet amputated? Yes No If Yes, skip 4-6 & Foot inspection within 24 hours of arrival Yes No 5. Was a foot ulcer(s) detected? Yes No If No, skip 6, Date & time foot ulcer(s) detected / / : 7. What was the patient s diabetes coding? Hypoglycaemia DKA Other HYPOGLYCAEMIA QUESTIONS 8. Was the hypoglycaemia resolved before arrival at hospital? Yes No If Yes, skip 9-11 Date & time hypoglycaemia detected / / : QUICK ACTING CARBOHYDRATE (QAC) 9. QAC administered Yes No If No, skip 10 & QAC administered within 15 min of hypo detection time? Yes No BLOOD GLUCOSE MONITORING 11. Blood Glucose monitored 15 min after QAC administered? Yes No DIABETIC KETOACIDOSIS (DKA) QUESTIONS Date & time DKA detected / / : EWS&GCS 12. Reason for not taking NEWS/GCS Yes No If Yes, skip 13 & NEWS within 60 min Yes No 14. GCS within 60 min Yes No Source of Admission Admission Method Admission Date & Time / / : Discharge Date / / Discharge Method Discharge Destination BLOOD TESTS 15. Reason documented for not performing blood tests Yes No If Yes, skip Blood tests repeated at least once within 4 hours of DKA detection (U&Es, serum bicarb) Yes No FLUIDS AND FIXED RATE INSULIN 17. Patient already on IV Fluids? Yes No If Yes, skip IV fluids commenced within 60min of DKA detection? Yes No 19. Patient already on Fixed Rate IV insulin? Yes No If Yes, skip Fixed Rate IV insulin commenced within 60 min of DKA detection? Yes No FOOT ULCER QUESTIONS ANTIBIOTICS 21. Reason/contraindication to antibiotic Yes No If Yes, skip Antibiotic administered within 6 hours of foot ulcer detection Yes No FOOT CARE TEAM 23. Reason documented for not being seen by hospital foot care team? Yes No If Yes, skip Date & time seen by hospital foot care team / / : OUTPATIENT APPOINTMENT 25. Reason documented for not booking outpatient appointment? Yes No If Yes, skip Outpatient appointment booked within 6 weeks of discharge? Yes No AQ Diabetes Data Form version 2.5 Page 28

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