Diabetes Medication Review in Acute Illness Audit

This project audits the quality, completeness and reliability of diabetes medication review during acute illness. It reviews reconciliation, assessment of oral intake, fasting and renal function, insulin safety, glucose monitoring, hypoglycaemia and ketone risk, medicine-specific review of SGLT2 inhibitors, metformin, sulfonylureas and GLP-1/GIP agents, specialist and pharmacist escalation, documentation of medication changes and restart plans, and discharge communication including sick-day advice.

• Acute medicine, emergency medicine and general internal medicine teams
• Ward pharmacists and medicines optimisation teams
• Diabetes specialist nurses and inpatient diabetes teams
• Ward leadership, nursing teams, ACPs and physician associates
• QI leads, governance teams and educators

• Measure reconciliation and review of diabetes medicines during acute illness
• Assess whether oral intake, fasting status, renal function and AKI are considered
• Review insulin safety, glucose monitoring and hypoglycaemia or ketone risk recognition
• Identify variation in medicine-specific review, escalation and discharge communication
• Generate governance-ready and ARCP-ready evidence

• Anonymous case identifier
• Inclusion / eligibility decision
• Anonymised biodata (age band, recorded sex/gender, care setting, assessment context)
• Documented diabetes type and diabetes medicines in use
• Clinical area / location and optional specialty / service
• Sixteen diabetes medication review criteria (met / not met / not applicable)
• Free-text learning points (this free ready-built project uses a fixed set of fields)

• Live dashboard
• Audit report (Word)
• Executive summary (Word)
• Excel workbook
• PowerPoint presentation
• Conference poster
• ARCP evidence summary

This ready-built project is developed using the guidance, standards and authoritative sources listed below, so you can see what is being measured and why. Lazomis QI does not publish or own this guidance, and inclusion here does not imply endorsement or approval by any of these organisations.

• NICE

  NG28: Type 2 diabetes in adults: management(opens the original source in a new tab)

  National guidance on the management of type 2 diabetes, including medicines choice and review.

• NICE

  NG17: Type 1 diabetes in adults: diagnosis and management(opens the original source in a new tab)

  National guidance on type 1 diabetes, including insulin therapy and illness management.

• NICE

  NG148: Acute kidney injury: prevention, detection and management(opens the original source in a new tab)

  Relevant where AKI or deteriorating renal function affects the safety of diabetes medicines.

• Joint British Diabetes Societies for Inpatient Care

  JBDS-IP inpatient diabetes guidelines(opens the original source in a new tab)

  Inpatient diabetes pathways, including VRIII, hyperglycaemia, steroid-related hyperglycaemia and DKA guidance.

• MHRA

  Drug safety updates: SGLT2 inhibitors and GLP-1 receptor agonists(opens the original source in a new tab)

  Safety advice relevant to diabetic ketoacidosis risk and to GLP-1 / dual GLP-1-GIP agents where locally used.

• Designed to use anonymised or pseudonymised audit identifiers.
• This tool supports, but does not replace, clinical judgement.
• Local policy, formulary and specialist advice should be followed.
• Organisations remain responsible for local governance arrangements.
• This tool supports, but does not replace, clinical judgement. Follow local policy, formulary, renal guidance and diabetes specialist advice.
• This is an audit tool, not a prescribing protocol: withholding, adjusting and restarting rules remain locally configurable.
• Use anonymous case identifiers only — never patient-identifiable information.

Supporting guidance from the Lazomis QI Resource Library. Authoritative clinical standards referenced by this project remain separate.

• Clinical GovernanceLeveraging Incident Themes for Quality Improvement and Patient SafetyThis guide helps NHS teams identify and analyse recurring incident themes, transforming reported safety events into practical quality improvement opportunities to enhance patient safety and system reliability.
• Patient SafetyHow to Select a Patient Safety Quality Improvement ProjectThis guide helps NHS teams identify and select patient safety quality improvement (QI) projects that are impactful, achievable, and aligned with organisational and national priorities. Learn how to move from identifying concerns to choosing a focused and measurable project.
• Patient SafetyIntegrating Patient Safety and Quality Improvement: A Practical Guide for UK CliniciansThis guide explains the foundational principles of patient safety and quality improvement (QI) within the UK healthcare context, offering practical strategies for clinicians to enhance safety and improve care delivery.
• Quality ImprovementDocumenting PDSA Cycles for Effective Quality ImprovementThis guide provides practical advice on documenting Plan-Do-Study-Act (PDSA) cycles, a crucial component of effective quality improvement in the NHS, ensuring learning is captured and shared.