Best improvement in quality of inpatient care initiative
The DICE programme demonstrates the effectiveness of inpatient diabetes teams
by Ipswich Hospital NHS Trust
The Diabetes Inpatient Care and Education (DICE) project was planned to reduce harm to patients with diabetes in Ipswich Hospital by establishing a fully-staffed, proactive inpatient diabetes team focused on improving care through innovation and implementation of new systems of care. These aimed to increase specialist surveillance of patients with diabetes, improve staff knowledge and awareness of the condition and evaluate its effectiveness by continuous audit. Innovative strategies and tools included an admission avoidance service, algorithms for admission units, the DICE Care Pathway, an innovative referral system (the Diabetes Patient At Risk score), use of web-connected blood glucose monitors, strategies to prevent nocturnal hypoglycaemia, a junior doctor induction programme and a foot protection pathway. Overall, hypoglycaemic rates reduced by 25% but severe hypoglycaemia fell by 46%.
"The judges felt the application shone with the supporting material. The whole story is in the “diabetes care pathway” form. This solid resource is easily shared and all the judges picked up on different elements of it."
Subcutaneous insulin for DKA safe, efficient and cost-effective
by St Mary's Hospital/Imperial College Healthcare NHS Trust
Most guidelines still recommend intravenous infusion of insulin as a means of managing uncomplicated diabetic ketoacidosis (DKA), with children on intravenous insulin infusion considered high dependency patients, requiring close monitoring from both nurses and doctors - even though they may be clinically well. The team adopted a different approach, treating them on the general paediatric ward with subcutaneous insulin. This is given to patients who are stable, with evidence of good peripheral perfusion (normal blood pressure, and capillary refill). In 4 years, 22 patients were admitted with moderately severe or severe DKA and all had a good response to insulin. The approach is safe and efficient, improves speed of recovery, reduces hospital length of stay and improves the patients’ and carers’ experience.
"The issue with people not taking their insulin is very important. This work is innovative, brave and defies conventions."