Improving inpatient care for people with diabetes at the Royal Berkshire NHS Foundation Trust:

1. Improving inpatient care for people with diabetes at the Royal Berkshire NHS Foundation Trust: The Think Glucose Project Naseem Sohpal

2. Introduction • 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

3. Issues Identified nationally • 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

4. What decreased length of stay insulin drug errors other adverse incidents cancelled procedures complaints delays in discharge inappropriate referrals National Pilot Results • 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

5. Our approach Steering Group : Executive level involvement Workstreams: Assessment/Referrals Patient Safety/Education Patient Experience Self management Coding Specialist Team involvement Clear guidelines/protocols on hospital intranet Diabetes Champions on all wards Individualised Care-plans Discharge Plan of Care

6. 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

7. Since Think Glucose: June 2010

8. 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

9. 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

10. 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

11. 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

12. Hypo Box Contents: 3 x Glucojuice 1 x pack 20 lucotabs 2 x Triple Packs Glucogel 1 x Glucagon IM 1mg (kept in ward fridge) Treatment Record Book Treatment pathway card The new Hypo Box for all wards and departments

13. Thank you Any Questions?