Diabetes Digital Monitoring: Building Back Better to Support Nursing Teams, Reduce Healthcare Inequalities & Empower Patients

Summary

Inpatient flash glucose digital diabetes monitoring has been implemented across the NHS Trust. This approach was designed in response to COVID-19 and achieved across a tertiary hospital, with devices offered to 350+ patients at the pandemic peak. The innovation allows closer monitoring of glycaemic control for at-risk patients with diabetes and COVID-19, empowers patients to manage their sugar levels, reduces inequalities in access to diabetes technology, supports overworked ward nursing teams and reduces exposure of staff to COVID-19. Patient and staff feedback was positive.

Innovation

During the COVID-19 pandemic, increasing numbers of patients needed glucose monitoring. Inpatient use of Freestyle Libre digital devices was proposed to empower patients to monitor their own sugars whilst in hospital, reducing nursing time spent on monitoring and reducing nursing exposure. The use of such devices in the UK is typically only funded for outpatient monitoring of people with T1DM. This population is typically white, young, and applies pressure through social media. Patients admitted to hospital requiring monitoring are commonly older, of diverse ethnic backgrounds, with multi-morbidity and are less digitally savvy. Introducing inpatient flash glucose monitoring would reduce inequalities in access. The project’s success meant its continuation beyond the pandemic. UHCW NHS Trust is the only one nationally to offer widespread inpatient flash glucose monitoring. Notably, with over 17% of inpatient beds occupied by people with diabetes, this initiative offers a remarkable opportunity to drive efficiency. The team worked with Abbott, the Trust’s Gold Command Group (including Chief Officers) and Nursing Leadership to roll out monitoring to all inpatients in the Trust with COVID-19 and diabetes. Abbott helped with deployment, taking into account factors such as X-ray, CT and MRI exposure, information governance and infection control. A ‘train-the-trainer’ package was developed for nurses, alongside bespoke patient and staff information leaflets. A distribution and troubleshooting system was established across the 1,100-bed organisation and re-use of the handheld monitors was enabled. A COVID-19 Action Fund Award from the Winston Churchill Memorial Fellowship Trust supported wider roll-out and evaluation.

Equality, Diversity and Variation

Over 350 people from the digitally neglected group were offered devices. Analysis showed 41% were people of an ethnic minority background. Wider implementation will help reduce the digital divide, particularly as the project is expanding to those recently discharged from hospital. Results demonstrate that those of an ethnic minority background readily adopt diabetes digital technology if it is presented in the correct way and appropriately supported. The average age of the cohort was 67.4, demonstrating that age should not be considered a barrier to adoption. Finally, 61% of the cohort were male, a population shown by the National Diabetes Audit to be underserved with diabetes digital technology. Importantly, the inpatient cohort had not previously been considered for flash glucose devices, despite calculations demonstrating cost effectiveness based on the time saving to nurses alone. The intervention reduced variation, being offered to all people with diabetes. The funding to extend the project explicitly looks at further reducing inequalities and also directly involving nursing teams in innovation and research.

Results

Flash glucose devices have been distributed to over 350 inpatients since April 2020. Of 69 staff who used them, 88% reported that they were ‘extremely easy to use’, 94% reported that they were very effective or extremely effective at reducing exposure to COVID-19, and 99% strongly agreed that the devices saved time compared to finger-prick blood glucose monitoring. Based on known prevalence of diabetes in hospital, the initiative can save between 112 minutes and 168 minutes per ward per shift (72 hours per month). The devices are simpler and require less dexterity than blood sugar monitoring and patients can check their sugar on demand. Feedback from patients has been positive. A total of 41% of responses were from patients of an ethnic minority background. Most required monitoring for T2DM or steroid induced diabetes, cohorts currently excluded from NHS funding for these devices. Patients’ suggestions led to development of a multi-language information pack for patients. Liaising directly with frontline nursing teams who were using the devices during their regular clinical work allowed optimisation of device distribution and training methods. As the project expands, the aim is to engage frontline nurses with protected time to be involved in the innovation. This includes 50% of an awarded Winston Churchill Trust Grant protected for nursing time to dedicate to this work, and an ambition to support two nurses to apply for further funding to undertake international fellowships dedicated to digital inpatient monitoring.

Dissemination and Sustainability

This project is sustainable, demonstrated by its cost effectiveness in terms of: time saved over finger-prick blood glucose testing and the cost of devices being significantly less than the calculated cost of nursing time saved. Sustainability is ensured by creating an online virtual education package to support low cost, rapid training of ward nurses, which cascaded in a train-the-trainer model. The industrial partner funded and hosted a regional training session to support wider adoption. Two papers have been submitted to journals to support dissemination of the work. The Winston Churchill Memorial Trust Grant will support the direct ambition of disseminating the intervention nationally across the NHS. This includes a robust health economic analysis and dissemination toolkit that should transform inpatient blood glucose monitoring and bring a culture change in approach to diabetes digital technology in the hospital. The aim is to develop a consensus statement supported by ABCD, Diabetes UK, YDEF and DISN to support this further important dissemination work.

User Feedback

Qualtrics software and a bespoke collection tool collated patient perspectives. Of the original 350 patients first offered devices, 213 provided responses. A total of 94% reported no challenges with sensor application; 87% reported they preferred the flash glucose system to finger-prick monitoring; 68% felt the devices gave them greater control whilst in hospital, and 79% reported the devices gave them greater confidence in using them. Nursing staff feedback is reported in Results above.

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QiC Diabetes Winner 2021
Patient Care Pathway, Secondary and Community
Diabetes Digital Monitoring: Building Back Better to Support Nursing Teams, Reduce Healthcare Inequalities & Empower Patients
by University Hospitals Coventry & Warwickshire NHS Trust

Quality In Care Diabetes

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  • 2022 KEY DATES
  • Open for entry:
    Monday 28 March 2022
  • Entry Deadline:
    Friday 1 July 2022
  • Judging day:
    Tuesday 6 September 2022
  • Awards ceremony:
    Thursday 13 October 2022