Use of workshops to improve diabetes management in Mental Health settings

1. Use of workshops to improve diabetes management in Mental Health settings Sarah Gregory Diabetes Specialist Nurse Diabetes UK Clinical Champion

2. Mental Health and Diabetes • A poorly written about area in diabetes • Psychological support for those with diabetes, but lack of physical support for those with poor mental health • Most mental health trusts are separate to Community and Acute Trust • Limited support from specialist services • There are only a handful of mental health trusts who employ physical health nurses specifically for diabetes • Patients ‘fall through the net’ between these services • Often a challenge to manage • Many mental health nurses are not dual trained • little knowledge of diabetes

3. Education Delivery – Primary and Secondary Care • In-Patient ‘Think Glucose’ programme • Three day course to cover all aspects of in-patient diabetes care • Two Modules for care homes – both based on TREND competencies and DUK guidelines • Module 1 – ‘Basic’ competencies – Different types of diabetes, symptoms, blood glucose monitoring, recognition and treatment of hypoglycaemia, Annual Review and footcare • Module 2 – Insulin Delegation – Safe use of insulin, hypoglycaemia, ‘Six Steps’

4. Kent, Surrey & Sussex Mental Health ProjectJune – September 2017 • Training needs discussed • Some funding from HEEKSS (Health Education England) • Remainder from Industry • High number of staff - not suitable for delivery in Modules • Self Assessment identified as baseline evaluation • Overview of Diabetes and Mental Health to ‘set the scene’ and four workshops in key risk areas: • Hypoglycaemia • Medication for Diabetes • Safe Administration of Insulin

5. Competencies • Based on the TREND competencies • Self Assessment by delegates pre and post course with 11 key questions in the management of diabetes • Delegates assessed themselves as ‘Competent’ ‘Almost there’ or ‘Not Competent’

6. Self Assessment QuestionsPart One (Overview) • Know the difference between Type 1 and Type 2 diabetes • Identify individuals at risk of diabetes – those of antipsychotic medication and poor mental health • Outline the long term health consequences of diabetes

7. Self Assessment Questions (Medication Workshop) • Demonstrate a basic knowledge of the range of oral anti-hyperlycaemic agents and their mode of action • Be aware of agents that which carry a higher risk of hypoglycaemia • Demonstrate a basic knowledge of the main groups of insulin and GLP-1 receptors agonists and administration devices used locally

8. Self Assessment Questions(Insulin Safety workshops) • Have an understanding of the importance of timing of insulin – be aware of common insulin errors • Know the importance of maintaining injection sites and site rotation - identify the term lipohypertrophy • Be able to correctly administer insulin and dispose of sharps -know how to use insulin pen devices or needles/syringes

9. Self Assessment Questions (Hypoglycaemia workshop) • Be able to define and recognise hypoglycaemia - be aware of medications most likely to cause hypoglycaemia • Know the treatment for hypoglycaemia

10. Data and Outcomes • A total of 134 staff attended the Workshops • Students Nurses to Consultants • A mixture of paper self assessments and electronic assessments • Electronic assessments easier to follow up and collect data • Evaluation of workshops and facilitators

11. Self Assessment – Pre and PostSurrey Mental Health Trust

12. Evaluation Data

13. Top Three things learned from the Workshops • More awareness of hypoglycaemia • 95% of delegates felt competent post workshop • Insulin Timing & Safe Administration of insulin (‘Rock n Roll’ and Safety Needles • Only 20% felt competent prior to workshop, 100% felt competent after • Medication groups • Only 5% felt competent in this area prior to workshop, still work to be done as this increased to 45%

14. Summary • Training and education programmes work but….. • They need to be relevent to practice and have key messages • They need to be sustainable (financially and human) • There should be Quality Assurance through self assessment and evaluation • They need to provide Continuing Professional Development (CPD)