In-patient diabetes – IT solution to support and enhance the Think Glucose project
by Sandwell and West Birmingham Hospitals NHS Trust
‘Think Glucose’ is a national initiative to improve in-patient diabetes care, including the use of a ‘traffic light’ system to give guidance to hospital staff as to which patients should be referred to the in-patient diabetes specialist team (IPDST). Keeping track of the 31 types of case referenced in the ‘traffic light’ scheme can be difficult, however, leading the Trust to develop an electronic form using its iSoft Clinical Manager (iCM) for ‘Think Glucose assessment’. This comprises a simple and mandatory tick box process to assess diabetes patients using the traffic light scheme, with the completed form then sent to the IPDST. Admin staff then add any patients who need to be seen by the IPDST to round lists. There has been a dramatic increase in the number of in-patients seeing the IPDST, while at the same time ensuring that the patients seen are only those requiring it according to the Think Glucose criteria.
"This was an extremely innovative initiative which will be a huge help in terms of picking up errors. The amount of detail in the submission was impressive and enabled us to really understand the initiative."
Admission to discharge: piecing together in-patient diabetes
by Royal Surrey County Hospital
Diabetes specialists designed a jigsaw-based education tool for use in the hospital environment to educate qualified pharmacists, nurses, healthcare assistants and junior doctors. The tool consists of 10 laminated module jigsaw pieces; a facilitator guide, which includes core healthcare professional learning objectives and a teaching plan for each jigsaw piece; activity cards for the group; and evaluation tools to assess the impact of the education programme. Piloted at four NHS hospitals, the tool improved healthcare professional confidence from 58 per cent to 94 per cent on a self-reported basis. Knowledge about diabetes was also increased, leading to improvements in the quality of in-patient diabetes care, such as reduction in management errors and increases in both the frequency of blood glucose monitoring and foot assessment. The tool is now available to all NHS hospitals in the UK.
SCI Diabetes In-patient tracking system – improving in-patient care using information technology
by Ninewells Hospital, NHS Tayside
Scottish Care Information – Diabetes Collaboration (SCI-DC) is the shared electronic record for the care of people with diabetes within NHS Scotland. NHS Tayside implemented a series of in-patient improvement initiatives using the SCI-DC to monitor in-patient outcomes and care end-points real time. This included a new SCI-DC tracking system to permit the identification of all patients with diabetes admitted to hospital. By obtaining accurate data on diabetes patients and outcomes, the specialist team was able to target certain in-patient cohorts for specialist input and support their management in hospital.
Reducing diabetes prescription/management errors
by Royal Bournemouth Hospital In-patient Team
Many prescription errors for people with diabetes are due to deficiencies in knowledge. To address this, the team redesigned the diabetes prescription chart for patients, including the addition of insulin initiation guidelines, how to titrate insulin doses, metformin guidelines and stated meal times. In addition, the ‘Safe Use of Insulin’ e-learning module developed by NHS Diabetes was made mandatory for all newly trained doctors, and a weekly review of all diabetes prescription charts enabled the team to identify errors very quickly. A Root Cause Analysis Prescription Error Pathway was also implemented, involving a targeted approach to education for the individual who made the error. There has been a significant reduction in prescription errors and Royal Bournemouth Hospital is now the best performing trust within Wessex with regards to insulin management and reduced errors.
Reducing length of stay and re-admission for people with diabetes awaiting elective surgery
by Royal Bournemouth General Hospital
Prior to 2011, the system in Bournemouth meant diabetes patients who had elevated blood sugar when arriving at the hospital for surgery were referred to the diabetes team on arrival. However, input at such a late stage offered limited value. This project introduced an intervention where it was recommended that patients with diabetes be referred for surgery if they had low enough blood sugar, with education provided to the pre-assessment nursing teams across all surgical specialties in order to optimise glycaemic control pre-surgery. Patients were also invited to attend a meeting with a DSN where they received an explanation of the implications and risks associated with glucose control and surgery. Surgery referrals were collected by the DSN twice weekly from pre-assessment areas and patients with HbA1c >8.5% were offered an appointment within ten days. Regular review based on individual needs was offered until surgery.