Pamela Pattison

1. 1. deficient nurse training on wards M4 and A11

   “nurse training on wards M4 and A11 was deficient and their understanding of the importance and danger of Type 1 Diabetes seemed to be limited at best”

2. 2. omission of long-acting insulin doses

   “ALL the doctors in training need to be aware that they should not omit any dose of 'long-acting insulin'”

3. 3. lack of specialist outreach nurse advice for diabetes

   “nursing staff on, for example, the surgical wards, did not have any specialist outreach nurse advice on such things as diabetes”

4. 4. absence of consultant cover for diabetes

   “There was an obvious need for additional consultant cover for Diabetes. | was told that funding has been put in place to cover this, but as yet no one has been appointed to fulfil this vital role”

5. 5. absence of specialist outreach nurse practitioner coverage

   “The specialist outreach Nurse [name redacted] for diabetes was booked off sick for one month, and no 'cover' was in place to cover his absence”

6. 6. inadequate access to required medical equipment

   “There was either a lack of equipment or a lack of understanding by the staff as to what equipment was needed by them. The staff indicated that they were unable to find 'ketone dipsticks', for diabetic urine sampling. | was told that in fact these are unnecessary in that ketone blood tests are now routine. Similarly | was told they could not find any or sufficient cardiac monitors on the ward. Further evidence revealed there are in excess of 240 such monitors in the hospital but the relevant staff”

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