Advancing Quality NHS Advancing Quality Alliance


‘Diabetes is a condition where the amount of glucose in your blood is too high because the body cannot use it properly. This is because your pancreas doesn’t produce any insulin, or not enough insulin, to help glucose enter your body’s cells – or the insulin that is produced does not work properly (known as insulin resistance)’

Diabetes UK

Through research, clinical input and clinical guidelines Advancing Quality has developed 16 measures that, when applied at the appropriate time, can greatly increase the outcomes for patients. Advancing Quality uses these measures to monitor the quality of care given to patients across the North West with the aim of improving standards and reducing variation in care.
All patients that are considered appropriate for inclusion in the Advancing Quality programme will be eligible for two initial diabetic measures. In addition to this and dependent on the patient’s condition(s) they may be eligible for additional measures relating to;

Diabetes was launched in November 2014. Participating trusts had a three month data collection period to ensure their systems were accurately recording the care patients received. Diabetes became part of the AQ conditions in February 2015.

Data for your local hospital will be available by February 2016.


1. Blood glucose levels checked within 30 minutes of hospital arrival

A quick and effective method of assessing your blood glucose levels and to identify high and low blood glucose levels.

2. Foot inspection within 24 hours of arrival at hospital

A simple visual examination of both feet (where applicable) is an essential part of caring for diabetic patients. It easily allows the identification of any foot ulcers or pre-ulcers and informs any additional care you may need.

3. Quick acting carbohydrates given within 15 minutes of low blood sugar detection

You should be given a quick acting carbohydrate such as glucose within 15 minutes of your low blood sugar being detected; this will help to bring your blood sugar levels back within the normal range. You should also receive long acting carbohydrates as a snack or part of a planned meal to help maintain your blood sugar levels.

4. Blood glucose monitored after administration of quick acting carbohydrate

Your blood glucose levels should be monitored at 15 minute intervals after you have received the quick acting carbohydrate, this should be done for up to 45 minutes or until your blood glucose levels have returned to within the normal range.

5. Escalation of care if blood glucose remains low after 45 minutes of quick acting carbohydrate being administered

If after 45 minutes your blood glucose levels have not returned to within a normal range your care should be escalated to a doctor or Diabetes Nurse Specialist for advice on the next stage of your treatment.

6. Cause of episode of low blood sugar discussed with patient before discharge

The cause of this instance of your low blood sugar should be discussed with you before you are discharged. This will help you manage your condition and prevent future re-admissions.
If you have DKA you should have two routine tests carried out on at recommended intervals to monitor your condition. Early warning score and the Glasgow Coma Scale assessments should be carried out routinely to allow identification of your survival risk factors and treatment required as well as the progress or deterioration of the DKA.

8. Blood and urine tests at regular intervals

The monitoring of blood and urine allows early identification of your biochemistry and the treatment required. You should have three tests that should be cried out at recommended intervals, they are; Urea and Electrolytes (U&E's) and serum bicarbonates via blood tests and ketones via blood or urine tests.

9. Fluids via IV drip within 60 minutes of DKA detection

Intravenous fluids are an essential treatment for the DKA patients to balance fluid and electrolytes; this prevents dehydration and subsequent risk of organ failure.

10. IV Insulin commenced within 60 minutes of DKA detection

Fixed rate intravenous insulin is essential in treating your DKA as it restores a normal blood glucose level and can prevent subsequent coma and mortality.

11. Reviewed by senior clinicians within 12 hours of DKA detection

A review by senior clinicians provides the specialist judgement on your proposed DKA treatment plan.

12. Foot ulcer description within four hours of detection

If appropriate details of the foot ulcer, by written description, illustrations or photographs allow details such as the size, position and depth of the ulcer is recorded, this helps in the development of a treatment plan including the need for any specialised wound care.

13. Antibiotics within six hours of foot ulcer detection

Early provision of antibiotics if your foot ulcer is not healing and shows signs of infection can help it to heal and prevent complications which could lead to gangrene and sepsis.

14. Referred to hospital foot care team within 24 hours

Ensuring you are referred to the foot care team within 24 hours means you will receive specialist assessments and treatment to support the healing of your foot ulcer.

15. Seen by hospital foot care team within 72 hours of referral

You should be seen by the foot care team within 72 hours of referral this enables you to receive the specialist treatment which can help in reducing the chance of your ulcer deteriorating and reducing the risk of you requiring a foot amputation.

16. Outpatient appointment booked with specialist team before discharge

An outpatient appointment booked with the appropriate specialist team ensures that any deterioration identified has a relevant management plan put in place to help you manage your care in once you are discharged from hospital, ultimately helping your ulcer heal and preventing amputation.
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