title: UK service level audit of insulin pump therapy in paediatrics.
abstract: OBJECTIVE
  To conduct an audit of insulin pump therapy in the UK after the issue of guidelines for the use of continuous subcutaneous insulin infusion by NICE in 2008 (Technology Appraisal 151).
  
  
  METHODS
  All centres in the UK, providing pump services to children and young people were invited to participate in an online audit. Audit metrics were aligned to NICE Technology Appraisal 151 and an electronic data collection tool was used.
  
  
  RESULTS
  Of the 176 UK centres identified as providing pump services, 166 (94.3%) participated in the study. A total of 5094 children and young people were identified as using continuous subcutaneous insulin infusion (19% of all paediatric patients with Type 1 diabetes), with a median (range) of 16.9 (0.67-69.4)% per centre. Units had a median of 0.58 consultant sessions, 0.43 full-time equivalent diabetic specialist nurses, and 0.1 full-time equivalent dieticians delivering the pump service. The majority of this time was not formally funded. Families could access 24-h clinical and technical support (83% units), although the delivery varied between consultant, diabetic specialist nurse and company representatives. Only 53% of units ran, or accessed, structured education programmes for continuous subcutaneous insulin infusion use. Most units (86%) allowed continuous subcutaneous insulin infusion use for paediatric inpatients, but only 56% had written guidelines for this scenario. Nine percent of units had encountered funding refusal for a patient fulfilling NICE (Technology Appraisal 151) criteria.
  
  
  CONCLUSIONS
  The number of children and young people on continuous subcutaneous insulin infusion therapy is consistent with numbers estimated by NICE. There is a worrying lack of funded healthcare professional time. The audit also identified gaps in the provision of structured education and absence of written inpatient guidelines.
authors.affiliation: Alder Hey Children's Hospital, Liverpool, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ghatak
authors.affiliation: Alder Hey Children's Hospital, Liverpool, UK.
authors.forename: P
authors.initials: P
authors.lastname: Paul
authors.affiliation: Alder Hey Children's Hospital, Liverpool, UK.|Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
authors.forename: D B
authors.initials: DB
authors.lastname: Hawcutt
authors.affiliation: Aintree University Hospital NHS Trust, Liverpool, UK.
authors.forename: H D
authors.initials: HD
authors.lastname: White
authors.affiliation: St Helens and Knowsley NHS Trust, St Helens, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Furlong
authors.affiliation: Warrington and Halton Hospitals NHS Trust, Warrington, UK.
authors.forename: S
authors.initials: S
authors.lastname: Saunders
authors.affiliation: The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
authors.forename: G
authors.initials: G
authors.lastname: Morrison
authors.affiliation: Countess of Chester NHS Trust, Chester, UK.
authors.forename: P
authors.initials: P
authors.lastname: Langridge
authors.affiliation: The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Weston
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000379:methods* / Q000592:standards; D002648:Child; D002985:Clinical Protocols / Q000592:standards; D003131:Combined Modality Therapy / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy / Q000188:drug therapy* / Q000451:nursing / Q000628:therapy; D003927:Diet, Diabetic; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007332:Insulin Infusion Systems / Q000009:adverse effects; D020407:Internet; D008019:Life Style; D008485:Medical Audit; D009043:Motor Activity; D020380:Needs Assessment; D010348:Patient Care Team / Q000592:standards; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D006113:United Kingdom; D000078329:Workforce