Endocrine Abstracts

Background: Knowledge of Cranial Diabetes Insipidus (CDI) is poor amongst healthcare professionals. Intra-nasal Desmopressin sprays are often mistaken for pulmonary inhalers, and Diabetes Insipidus mistaken for Diabetes Mellitus, leading to incorrect management and harm. Correct Desmopressin administration and fluid management is paramount in inpatients, especially in reduced conscious states.

Aim: To explore Clinicians’ concerns regarding safety issues arising from inpatient management of CDI over last 2 years.

Methods: A survey with the following 5 questions was sent electronically to 1195 members of the Society for Endocrinology:

• The clinician’s role.

• If they had concerns regarding the management of an inpatient with CDI in the last 2 years.

• Did this result in significant harm or a near miss?

• Details of safety issue.

• If there are initiatives in their Trust to support the safety of patients with CDI.

Results: 200 responded: 68% Consultants; 18% Registrars; 12% Nurse Specialists and 2% others. 55% had concerns regarding the management of a patient with CDI within the last 2 years. Of these, 47% of responders reported significant harm or near miss due to omissions of Desmopressin, non-availability, incorrect prescription, incorrect recognition of CDI, suboptimal fluid status assessment, hypo- and hypernatraemia, cerebral oedema and death. The most common reason for a safety issue was related to the prescription and/or administration of Desmopressin. 41% (82/200) reported that their Trust supported safety initiatives for optimal management of CDI.

Discussion: Inpatients with CDI continue to be at risk of significant harm due to the paucity of healthcare professionals’ knowledge, and needs addressing imperatively. Crucial messages of Desmopressin as a life-sustaining medication, meticulous fluid management and the need for early Endocrinology input needs to be widely disseminated. Trust-wide safety initiatives, electronic pharmacy alerts and perhaps a change in nomenclature of Diabetes Insipidus may all be useful interventions in reducing risk.