A survey of diabetes management in nursing homes: the need for whole systems of care

A structured questionnaire survey of nurse managers of the 40 nursing homes in the catchment of a district hospital revealed inconsistencies in diabetes care and unsafe capillary blood testing practice. Seven homes had diabetes management policies; in the 33 homes that did not, management was based on information received at admission being incorporated into the care plan. Regarding the management of ill insulin‐dependent residents, nine homes stated that insulin should be withheld although all homes indicated that they would increase the frequency of blood glucose monitoring and seek advice. 18/40 homes had a policy for the management of a hypoglycaemic episode; those without a policy relied on the knowledge of the trained staff present. Sharing of blood sampling equipment within homes, a risk to infection control, was identified as commonplace. A lack of guidance appeared a major cause of inconsistency in patterns of ongoing care for residents with diabetes. Specific guidelines and training are required to assure diabetes care and clinical governance in care homes.