Summary
According to National Diabetes Inpatient Audit (NaDIA) (2017) data, 18% of all hospital inpatients have diabetes. Most of these patients are admitted into hospital for non-diabetes-related reasons and therefore are cared for by non-diabetes specialist teams. Suboptimal hospital management of diabetes can lead to increased length of stay and has been linked to increased morbidity and mortality rates. Delivering robust, measurable and standardised insulin safety training is challenging, as shifts are busy, often understaffed and agency or bank nurses are routinely used. Plus, 28% of hospitals do not have dedicated diabetes specialist inpatient nurses to support training. Cambridge Diabetes Education Programme (CDEP) collaborated with Dr Rice, Chris Cottrell and PocketMedic to create a ‘bite-sized’ educational film and competency-based e-learning topic to support ward staff to improve insulin safety skills and reduce insulin errors.
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Innovation
It is recognised that there is a lack of knowledge among non-diabetes specialist ward staff about insulin. Face-to-face training is poorly attended due to staffing and workload pressures and insulin requirements can change rapidly. Nurses can face an array of different insulins and delivery devices. Access to diabetes specialist advice is often limited, especially at night or over weekends. This digital innovation addresses the time pressure issues that staff experience as the training is deployed quickly and is accessible at point and time of need. Staff can build or confirm their knowledge in minutes. Key incidents and ‘never-events’ that have caused death or serious outcomes are flagged in the film and addressed in the learning topic. Offering standardised training UK-wide helps assess knowledge, boosting confidence and guideline familiarity. Commissioners/trust diabetes leads can access real-time, aggregated staff learning activity data to identify gaps in knowledge, which can be addressed in-house. CDEP’s reporting mechanisms can contribute valuable staff training competency data to national diabetes audit data, potentially informing system-wide improvements.
Method
Dr Rice, PocketMedic and CDEP discussed collaborating on an insulin safety animation and e-learning topic in September 2018. CDEP sought the opinions of a wide variety of inpatient diabetes experts and an informal steering group was created. The topic has two levels. The core level is suitable for any ward staff, registered or unregistered, from any discipline. The intermediate level builds on this core knowledge to support registered ward staff to apply the knowledge in practice. The topic and film were tested by the steering group and diabetes specialist staff across the UK and content was refined prior to final testing by ward staff and people living with diabetes. In total, 102 tester evaluations were collected. Each tester provided a score (on a five-point scale) on eight dimensions, from clarity and appropriateness of language to relevance and quality of resources used, website functionality, and so on. Average feedback was 4.3 out of 5. The film is five minutes long and the topic is designed to be completed in 45-60 minutes. The topic pass mark was 80%. It was offered free in May as part of the UK-wide insulin safety drive spearheaded by Insulin Safety Week (ISW). CDEP worked with ISW organisers to help raise awareness of the training. Outcomes of uptake and effectiveness are continuously measured and reviewed via CDEP and PocketMedic’s audit tools, as well as social media analytics reports.
Results
Early feedback indicates that this insulin safety training has been well received and is successfully supporting staff competency, confidence and guideline familiarity. The training was formally launched on 1 May 2019. In the first month, 283 healthcare staff from across the UK successfully completed the topic. Feedback reported: 260 (92%) improved or significantly improved and 22 (8%) confirmed their competency; 254 (90%) improved or significantly improved and 27 (10%) confirmed their confidence; 262 (93%) improved or significantly improved and 21 (7%) confirmed their guideline familiarity. Users took, on average, 40 minutes to complete the core topic and 60 minutes to complete the full intermediate topic. While the topic focused on insulin safety in a hospital setting, healthcare staff working outside the inpatient setting reported benefits too. In May, the film had been viewed online 3,037 times. It had been downloaded 35 times for offline use in presentations for in-house insulin safety training across the UK. Twitter (36.3K impressions in May), Facebook (4,607 post views and 71 clicks) and LinkedIn (1,653 post views) were utilised to promote the film and topic.
Sustainability and Spread
As a result of the success of this training, further funding has been secured to make specific films for each type of insulin, from rapid to long-acting, from pre-mixed to high strength. A second film and topic on ‘Safe use of Insulin’ is being developed to support insulin safety skills in staff working in community, care homes and general practice settings. At the end of May 2019, CDEP had 10,673 healthcare staff registered on its e-learning platform. CDEP was growing at the rate of 800-1,500 new users per month. 15,535 topics have been successfully completed by healthcare staff. CDEP is used as a diabetes staff training tool in 40% of English Clinical Commissioning Groups (CCGs) and throughout Wales. CDEP continues to work with commissioners and diabetes training leads to make healthcare staff aware of the diabetes learning opportunities and support those already registered to make best use of the topics. It has a well-established communication strategy to continue to widen its reach and promote a greater uptake of diabetes training. Since the launch of the insulin safety training, a greater number of CDEP registrations (55% in all new registrations in May) were from areas that have not yet taken advantage of the diabetes e-learning offered. CDEP outcomes are regularly audited and published on its website. They are also presented annually at the Diabetes UK conference. The team is looking for funding to make a new film addressing VRIII use. There is interest in re-recording the voiceover in Hindi and Australian.
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