1. 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

2. 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%)

3. 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

4. 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

5. 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’

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

8. 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

9. 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

10. 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

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

16. 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

17. 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)

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