Patients with diabetes are more vulnerable to acute illness leading to hospitalisation, and those with pre-established renal disease are especially at risk of acute chronic kidney injury (AKI). ENHIDE developed a pocket-sized sick day guidance card to fit in wallets and purses for all patients with diabetes, and over 50,000 cards have been made available for patient use, with priority given to those patients admitted acutely with AKI, with the aim of reducing avoidable hospitalisation.
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A pocket-sized sick day guidance for patients with diabetes that empowers patients to better manage a range of medication and seek early medical input when unwell with infection or potential volume depletion. There are no such cards routinely used in UK - the Scottish Renal card does not have information about the range of medications used for diabetes in addition to other therapies that increase the risk of acute renal or metabolic emergencies and no cards have been utilised throughout the health economy in both acute and community settings. We have piloted this at time of hospital admissions with diabetes patients with acute kidney injury, around one in three of such admissions. We are unaware of other centres that have developed and utilised such a card with a roll-out in both acute and primary care settings
As part of an East of England Academic Health Science Network (EAHSN) initiative to reduce hospital admissions with hypoglycaemia, we developed a sick day rule card initially to cover those with diabetes in the five million population of the East of England. In practice East and North Herts have been the key centre to take this opportunity on and to align this with the local telehealth projects and the current annual GP practice visits that consultants make to upskill and educate primary care teams. The EAHSN project has led to closer working with the Herts Prescribing advisor teams opening up the possibility of wider access to the cards for many more diabetes patients picking prescriptions up from the pharmacies. The roll-out of the cards through practices has started in earnest and will be linked to the telehealth projects - at present we have accessed 15 practices and will be engaging with another 26 over the months till October 2017. Thereafter we will continue to review renal patients through telehealth visits but would only anticipate that those visited till October 2017 will have a one-year review to assess whether there had been any suggested impact on acute hospitalisation.
The cards have been well received by patients and by primary care through consultant-led practice visits and engagement regarding those with CKD under primary care as part of a renal telehealth project. The cards have been issued to over 500 patients in clinics . A supply will be given to the local Pharmacy Lead to distribute to all local pharmacies when dispensing diabetes medication, and each practice visited by the Telehealth team has been issued an initial supply of 200 cards per practice. Patients attending diabetes renal clinic have advised us that they have used the card and the absence of admission and restarting treatment appropriately is recognition that the advice has been of value.
Sustainability and Spread
There is no reason why we can’t utilise this approach in all areas throughout UK and beyond. The clinical audit of admissions with diabetes and AKI will continue along with the renal telehealth project until the middle of 2018 but thereafter regular access to sick day guidance cards will continue with updates, especially given the very low cost of production of the cards (£350 for 50,000 cards).
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