This award recognises the importance of providing specialised, tailored and safe care to people with diabetes while in hospital.
Project to reduce the frequency of hypoglycaemia amongst adult inpatients at Bedford Hospital
Bedford Hospital NHS Trust
The project undertaken by the inpatient diabetes team at Bedford Hospital was to reduce the number of adult inpatients experiencing hypoglycaemic events. This was devised following poor results at local and national audits. The baseline knowledge of healthcare professionals at Bedford Hospital was demonstrated to be poor, and documentation of blood glucose readings and action on hypoglycaemia events was inadequate. The project consisted of specific training schemes for ward nurses, junior doctors and senior doctors, along with gaining support from senior hospital management, monthly audits with individual feedback and a total redesign of the blood glucose documentation chart. A 50 per cent reduction in hypoglycaemic events and a 60 per cent reduction in recurrent hypoglycaemic events was achieved as well as a marked improvement in patient experience and staff knowledge on the most recent National Diabetes Inpatient Audit (2011).
"They got every single doctor in the hospital educated in diabetes which is amazing. With a lot of programmes half the battle is making sure people understand it.”
"Hypoglycaemia is an incredibly neglected area. What impressed me was the fact that they linked this to a CQUIN initiative and if they were able to deliver as promised they would achieve a £184,000 saving."
Reducing hypoglycaemia and improving inpatient diabetes care at Royal Hampshire County Hospital
Hampshire Hospitals NHS Trust
The latest Think Glucose campaign began in July 2011 focusing on the reduction of hypoglycaemia episodes, recorded examination of a patient’s feet and improved patient safety during an inpatient stay. This initiative involved a diabetes nurse giving an introductory session to two wards at a time on the importance of management of diabetes in clinic care, with a one hour follow-up session specific to the needs of the ward staff. Wards were visited by the diabetes team twice weekly and additional telephone support given where necessary. During each shift, ward staff nominated a healthcare assistant as the meal coordinator who identified patients with diabetes on the ward and alerted nursing staff to administer insulin. The Safe Use of Insulin e-learning module was made mandatory within the hospital for all clinical ward staff and pharmacists, and a foot-shaped stamp was made to be incorporated into patients’ medical records to signify a foot check had been completed. Results showed that the incidence of mild hypoglycaemia decreased from 30.5 per cent to 17 per cent and severe hypoglycaemia decreased from 17 per cent to 12 per cent. 60 per cent of patients also had a documented foot examination compared to 27.3 per cent in the previous year.
Piecing Together Diabetes' Inpatient Education Tool
Royal Surrey County Hospital NHS Trust and Eli Lilly
Diabetes specialists at the Royal Surrey County Hospital designed in partnership with Eli lilly an innovative inpatient educational tool for use in the hospital environment to educate qualified pharmacists, nurses, healthcare assistants and junior doctors. The large puzzle design consists of nine individual jigsaw pieces; each piece covers a key aspect of inpatient diabetes care from admission to discharge. Each puzzle piece does not need to be completed in its entirety, and can be broken down further into activities, discussions and practical skills of smaller blocks of time so it can easily be adapted to the time available or to address a specific training need. The tool enhanced the confidence and knowledge of healthcare professionals, improved appropriate blood glucose monitoring from 67% to 92% and appropriate hypoglycaemia management improving from 9% to 75% and documented foot assessment from 15% to 33%.
The University Hospital Southampton Inpatient Diabetes 3D project
University Hospital Southampton NHS Foundation Trust
The University Hospital Southampton hosts up to 120 diabetes patients at any one time. A large proportion of these patients are under the care of cardiologists, vascular, cardiac and orthopaedic surgical teams (division D). Following a successful bid to the trust innovation fund, the manpower of the diabetes team was increased for three months, enabling the Trust to provide daily proactive review and optimise diabetes care for all patients under division D. Ward staff were provided with bespoke diabetes education and were encouraged to ensure that all inpatients with diabetes were highlighted on the patient nameboards, to improve team and time efficiency. A full diabetes ‘bedside clinic’ review was also given to all patients, including foot examinations. In a review of 391 patients over three months, length of stay was reduced, the number of inappropriate blood glucose tests was reduced, re-admission rates for diabetes patients were reduced and 45 diabetes drug related errors were prevented.
A new Acute Diabetic Foot pathway for Southend
Southend Hospital NHS Trust
The ‘Wound Management Team’ (WMT) at Southend Hospital NHS Trust was formed after a complex wound problem became further complicated by a delay in surgery. The team was formed by combining two specialist nurse groups supported by a vascular surgical consultant. This was closely followed by the formation of a dedicated Wound Management Unit (WMU), allowing for the creation of a new pathway for diabetes patients with serious foot problems. Since this pathway was created, the rate of lower limb amputations in patients with complex wound needs has been reduced by 50 per cent. This has been helped by a multi-professional approach to care, with dedicated beds and a ward based specialist team which has pathways working across and in conjunction with the PCT specialist services. Having these service improvements accepted into local constitution has allowed for continual improvements in service delivery and patient outcomes.
Diabetes and Foot Disease: Standards of Care in Hospitals
Nottingham University Hospitals
Patients with diabetes and foot disease are at high risk of below knee amputations, hospital acquired infections and worsening kidney disease. To address this, a targeted inpatient multidisciplinary foot care team was set up to create an inpatient hub for specialist foot care with ready access to a wide range of healthcare professionals (diabetologists, ankle and foot surgeons, a medical microbiologist, vascular surgeons, ward nursing leadership, podiatry and orthotics). They were successful in establishing a specialist ward and a multidisciplinary team following Trust wide objectives to reorganise beds and reduce hospital acquired infections. This effort has improved direct access to the specialist team and ward, reduced length of stay as well as a decrease in hospital acquired infections, and greatly improved patient and staff satisfaction and staff development.
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