Implementation of a National Guideline with Local Changes: Does an Abbreviated Adult Diabetic Ketoacidosis (DKA) Protocol Improve Local Uptake and Overall Clinical Care?
by Sandwell & West Birmingham NHS Trust
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Management of Diabetic Ketoacidosis (DKA) remains a significant clinical problem in hospitals. Morbidity, mortality and length of hospital stay are negatively affected unless this life-threatening condition is diagnosed and treated quickly. The Sandwell and West Birmingham NHS Trust’s junior doctors and nursing staff found the Joint British Diabetes Society guidelines on DKA too lengthy and complicated, resulting in poor adherence. In August 2015, the document was abbreviated from ten to two pages. Audit in 2015-16 showed significant improvements in adherence, management outcomes, user satisfaction and length of stay and the revised protocol became standard in the Trust.
"Sandwell & West Birmingham NHS Trust have produced a very simple but very impressive project. The step by step protocol allows underlying causes, as well as treatment of DKA, to be identified, which will help practitioners improve care. The project generated compelling positive feedback from users, suggesting that its clinical impact could be significant. Already in routine practice, the sustainability of the programme is clear, with evidence of its adoption in other localities."
Introducing Flash Glucose Monitoring at Scale with Educational Support
by NHS Lothian
Flash glucose monitoring (FM) was introduced in the UK in 2015, but limited to those who could purchase their own sensors. A lack of strong evidence of benefit (particularly with respect to lowering HbA1c) hindered NHS funding. Work began to highlight the threat of widening social inequalities in outcomes in Type 1 diabetes (T1D) (related to inequitable access to FM) and contributed to an evidence base for efficacy. This information secured liberal eligibility criteria for FM within the Lothian health board and an educational programme ensured 50% of the T1 population were using NHS-funded FM within six months.
"The planning and execution of this project to improve uptake of Flash Glucose Monitoring was superb, and resulted in rapid uptake within a very short timeframe. The project has set a high standard for other regions in Scotland to follow, and establishes a platform for more evidence-gathering of clinical impact e.g. HbA1C reduction."