The specialist diabetes dietetic team has been inundated with requests from dietetic colleagues of all grades and across both the acute and community teams to support them in delivering dietary advice to patients with diabetes. To assist them the team developed a diabetes competency training programme for dieticians working. 75% of dieticians within the adult service Oxfordshire have since attended it and assessments have shown the structured education improved diabetes competencies in dieticians.
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Dietary management plays a key role in managing diabetes, and in Oxfordshire this is provided in the community and in hospitals by health professionals, including dieticians, who have not received specialist training. Both practice nurses and people with type 1 diabetes have reported that health professionals’ diabetes knowledge is inadequate and outdated, and there is widespread recognition that more training is needed in the nutritional management of diabetes. The only diabetes education programme linked to competencies is an online programme provided by the Cambridge Diabetes Education Programme (CDEP), and this is a learning tool that covers all aspects of diabetes care and is not specific to diet. There is no other diabetes competency training programme for non-diabetes specialist dieticians that can be delivered face-to-face, in-house and that demonstrates an increased competency after the training has been completed.
The aim was to design and evaluate a structured education programme to improve diabetes competencies in non-specialist dieticians working in the adult service in Oxfordshire. The objectives were to ensure that it met the Department of Health-identified four key components for programmes (a structured, written curriculum, trained educators, quality assurance and audit and evaluation of both biomedical and quality of life outcomes). Also, that the content matched the published competency framework for dieticians, improved knowledge and skills of participants and was well received - and would therefore be recommended to colleagues in the future. Two three-hour sessions were designed, matched specifically to the published competency framework for dieticians, with topics including: pathophysiology, epidemiology and clinical guidelines; teaching and learning skills; individualised and group-based structured self-management education; and psychosocial and behavioural approaches. The topics were allocated to the six diabetes specialist dietitians involved so each could take ownership to ensure all information was up to date and evidenced-based. More detailed criteria for education programmes were identified and included the recommendations that all programmes should be patient-centred and incorporate individual assessment, they should be reliable, valid, relevant and comprehensive, theory-driven and evidence-based, flexible and able to cope with diversity, able to utilise different teaching techniques, resource effective with supporting materials, written down (this included philosophy, aims and objective, timetables and detailed content) and finally that they should be subject to robust audit and evaluation.
75% of eligible dieticians had attended the programme by the end of September 2016. There have been 50% fewer requests for advice and support about appropriate dietary advice for people with diabetes and fewer enquiries about which service to refer patients to from colleagues who attended the programme, demonstrating increased efficiency. 83% of dieticians completed qualitative evaluation using VAS and the overall scores were:
- 90% for usefulness of the sessions
- 85% for increased knowledge
- 82% for increased confidence
Although funding was received from Oxford University Hospitals NHS Trust Charitable Funds to pay Pamela Dyson to co-ordinate the development of the programme and help with the course facilitation, the input from the diabetes dietetic team came from within existing resources.
Sustainability and Spread
This programme is sustainable as it is able to be delivered within existing resources. The programme will need to be updated as guidance changes but this is a realistic workload for the diabetes team. It is anticipated that the programme will be delivered annually to all new staff and that an update session will be delivered every two years so that all staff can maintain their competency. A register has been compiled of the staff that have attended the competency training as part of our departments quality documentation. The programme is reproducible and could be used for any acute or community dietetic department. At the Diabetes UK Annual Professional Conference 2017 we were approached by other departments who are interested in purchasing the programme to run in their departments. We have also been approached by other disciplines such as Oxfordshire Bariatric Service and Oxfordshire Diabetes Specialist Nursing Team who feel the programme would be beneficial to their staff members.
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