Improving In-patient Diabetes Care Ruth Miller RGN BSc (Hons) Diabetes Nurse Consultant NWL STP Diabetes Transformation Programme MSc (Inpatient risk management) Diabetes UK Clinical Champion F

128,992 patients in NWL with diabetes Scale of diabetes problem in North West London 128,992 patients in NWL with diabetes 29.4% of emergency admissions 28.3% of NWL bed days £340m NWL spend on diabetes (~10%)

10,419 for diabetes patients with angina Diabetes bed days in NWL for complications (2013) 10,419 for diabetes patients with angina 9,242 for patients with a myocardial infarction 32,162 for patients with heart failure 10,967 for patients with a stroke 11,679 for patients needing dialysis 2,509 for patients undergoing amputations

Why is diabetes managed poorly in hospital? Increasing diabetes prevalence Disparity in diabetes training/knowledge Inconsistent/non-standardised practices & protocols Complex diabetes managed by non-specialist ward staff Complex diabetes presentations & co-morbidities Diabetes & Dementia Increased pressure to discharge

National Diabetes Inpatient Audit highlights ‘Shocking’ failings in hospital Care (DUK 2014) Medication errors made with alarming regularity by majority of hospitals Large numbers of patients not having foot checks 1 in 10 inpatients having serious hypo during stay ‘Raising serious questions about the ability of hospitals to provide even the most basic level of diabetes care’

What can be done to improve inpatient safety and to reduce the variability in the quality of inpatient diabetes care?

Diabetes 10 point training Turning a light on in a dark room? Basic diabetes skills training 10 core competencies to keep patients safe Training is fast and to the point Aim is to make a lasting impression Speed dating of the education world Train all ‘patient facing’ staff

What has been done in the past? 900 patient facing staff trained in Diabetes 10 Points Have trained nurses, midwives, doctors, HCAs physiotherapists, occupational therapists, theatre technicians, pharmacists. Effectiveness of training evaluated through self reported confidence questionnaires Incidence of diabetes related SUIs and National Diabetes Inpatient Audit results

NaDIA results comparison Trustwide events recorded at Poole (NaDIA) Pre 10 Point Training (Sept 2015) Post 10 Point Training (Sept 2016) Medication Errors 46.9 26.7 Insulin Errors 24.5 13.3 Prescription Errors 38.8 15.0 Severe Hypoglycaemia (CBG < 3mmol/l), % 14.5 6.9

Point number 1: The Patient Listen to the patient: they manage their diabetes 365 days a year

Advantages Can be adapted to any hospital or community setting Inexpensive Quick and to the point No time to lose concentration! Other modules Flexible training made relevant to ward specialty

Measuring effectiveness Pre & post training questionnaire on self- reported confidence in managing the 10 points NaDIA drug, prescription & administration errors Incidence of Serious Untoward Incidents (SUI)

Future Make mandatory Develop other formats e.g. online training/DVD Community 10 point training Complete 10 point training for Mental Health Workers