AUDIT OF CARE OF NEWLY-DIAGNOSED CHILDREN WITH DIABETES-MELLITUS IN EAST-ANGLIA

The aim of this study was to audit the organization of services and ma nagement at diagnosis of Type 1 diabetes mellitus (IDDM) in children i n the eight districts of East Anglia. Representatives of each district met and agreed indicators of goad practise. Service organization was assessed by questionnaire. Provision of care was audited using a profo rma completed prospectively for every newly diagnosed child. Outcomes were audited by an anonymous questionnaire to families at the first ou tpatient appointment to assess satisfaction with care, the education r eceived, and confidence in basic skills needed for home care of diabet es. All districts had a designated paediatric diabetic clinic, all but one led by a paediatrician. All had nurse specialists, but the posts varied widely. Only three units had joint clinics for adolescents. In total, 75 % of the families returned the questionnaire. Satisfaction w ith support by health professionals was high. Education was good for i njection technique, blood testing and diet management. Home visits by nurses were variable. Contact with schools and introduction to support groups was poor, Confidence in management was best when there was a d edicated paediatric specialist nurse with adequate cover within the te am to allow home and school visits. Following peer review and implemen tation of an action plan, reaudit was undertaken one year later. Modes t improvements were achieved in problem areas; solutions varied in dif ferent districts. Collaborative, multi-district audit allows compariso n between demographically similar districts. Audit encourages improved practice within existing teams and allows an informed bid for scarce resources. (C) 1997 by John Wiley & Sons, Ltd.