An evaluation of a specialist nurse prescriber on diabetes in-patient service delivery

The aim of this study was to evaluate the impact of a diabetes specialist nurse (DSN) prescriber on insulin and oral hypoglycaemic agent medication errors, length of hospital stay, and patients' ability to self-manage their diabetes whilst in hospital. The setting was six wards in a single United Kingdom district general hospital trust. The standard in-patient care of a convenience sample of diabetic patients treated with insulin and/or oral hypoglycaemic agents was evaluated before (n=187) and after (n=266) the intervention of a DSN prescriber. Prospective data were collected in order to measure insulin and oral hypoglycaemic medication errors, and length of stay (i.e. primary outcome measures). A secondary outcome, the extent to which patients felt able to manage their care, was measured using a self-report questionnaire. The results showed that the median number of insulin and oral hypoglycaemic agent medication errors was lower in the intervention group (four vs six, p<0.01). The median length of stay was less for patients in the intervention group (seven vs nine days, p<0.05). In all, 61% (59/96) of patients in the pre-intervention group, compared with 71% (90/126) of patients in the intervention group (p=0.118), reported that they were able to manage their diabetes during their hospital stay. It was concluded that a DSN prescriber reduced prescribing errors. This reduction had some effect on length of stay. The cost saving was at least sufficient to self-finance the cost of a DSN prescriber post.