improving inpatient care for people with diabetes at the royal berkshire nhs foundation trust:
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Improving inpatient care for people with diabetes at the Royal Berkshire NHS Foundation Trust: The Think Glucose Project Naseem Sohpal. Introduction. THINK GLUCOSE is a major new programme from the NHS Institute Designed to improve the management of people with diabetes in hospital - PowerPoint PPT PresentationTRANSCRIPT
Improving inpatient care for people with diabetes at the Royal Berkshire NHS Foundation Trust:
The Think Glucose Project
Naseem Sohpal
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• THINKGLUCOSE is a major new programme from the NHS Institute
• Designed to improve the management of people with diabetes in hospital
• Provides tried and tested products to improve awareness and remove obstacles
• Promotes proactive care in those patients with diabetes as a secondary diagnosis
Introduction
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• Errors in the prescription and administration of insulin
• Inappropriate treatment of hypoglycaemia
• Limited Staff knowledge of diabetes
• Inappropriate referrals to the diabetes team
• Lack of early screening and communication
• The type and timing of meals
• Failure to involve people in the management of their diabetes
• Lack of a clear and established care pathway
Issues Identified nationally
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What increased
• overall quality of care
• patient safety
• bed efficiency
• diabetes team utilisation
• staff knowledge and awareness
• patient satisfaction
• income (more accurate coding)
• staff satisfaction
• resource efficiency
What decreased
length of stay
insulin drug errors
other adverse incidents
cancelled procedures
complaints
delays in discharge
inappropriate referrals
National Pilot Results
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Our approach
Steering Group :
Executive level involvement
Workstreams:
1. Assessment/Referrals
2. Patient Safety/Education
3. Patient Experience
4. Self management
5. Coding
Specialist Team involvement
Clear guidelines/protocols on hospital intranet
Diabetes Champions on all wards Individualised Care-plans Discharge Plan of Care
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Why?
RBHFT point prevalence study revealed that only 9% of diabetic patients who needed a referral were referred
Easier for ward staff to determine whether the diabetes team input is required for individual patients
The referral tool will ensure that referrals to the diabetes team are appropriate and timely
It helps ensure that the diabetes team are able to target their efforts and focus their input on the patients
All patients with diabetes who are admitted into hospital will have this assessment completed
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Since Think Glucose: June 2010 Referrals to the Diabetes team
0
50
100
150
200
Janu
ary
Febr
uary
March Ap
ril
May
June Ju
ly
Augu
st
Septe
mber
Octob
er
Nove
mber
Dece
mber
2008 2009 2010 2011
CCU / CDU pilot 21/06/2010
Roll out - Medicine and part Surgery, end August
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Some adverse incidents/errors
Late referrals – discharge delays
Incorrect use of syringes
Misuse or mismanagement of IV insulin infusions
Discontinuing IV insulin inappropriately
Prescription errors- insulin omission or delays in insulin administration
Mismanagement of Hypoglycaemia
Timing of food and insulin dose
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Role of Diabetes Specialist Team at the RBFT
To review all appropriately referred inpatients – currently 150 -180 per month seen by Diabetes nurses plus doctor ward rounds
Diabetes nurses provide patient education and follow up support by telephone helpline
Advice and support to all staff eg. medication, insulin administration devices, blood glucose monitoring, IV sliding scale
Involvement in staff teaching eg pharmacy staff, Physiotherapy, Podiatry, and Occupational Health on Hypoglycaemia management
Involvement in Induction Programmes both doctors and nurses
Supporting Ward teaching programme by Practice Development Team – Thank you to the Practice Educators
Development of Protocols and guidelines eg Sliding Scale Insulin and Endoscopy leaflets for patients
Appropriate Discharge Planning- using our Think Glucose Discharge Plan of care
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How we measure Progress with Think Glucose
Weekly ward audits on referrals
Diabetes Nurses audit on number of appropriate referrals
Diabetes nurses audit on date of referral to date of action
Diabetes nurses audit on Discharge plan of Care
National Diabetes Inpatient Audit - annually
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Further New Initiatives at the RBFT
New Hypo Boxes in every ward and Department
Patient Self management of Insulin in hospital
Blood Ketone testing for patients admitted with Diabetic Ketoacidosis
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The new Hypo Box for all wards and
departments
Hypo Box Contents:
3 x Glucojuice 1 x pack 20 lucotabs2 x Triple Packs Glucogel1 x Glucagon IM 1mg (kept in ward fridge) Treatment Record BookTreatment pathway card
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Thank you Any Questions?