Experiences shared at inpatient conference

By Editor
28th June 2016
Good practice, Inpatient Latest news

Experiences of inpatient diabetes care and improvement initiatives were shared at the 5th National Diabetes Inpatient Conference has taken place.

Diabetes professionals gathered at the Royal Society of Medicine for the annual CPD- accredited event earlier this month.

Organisers said this year the meeting would “create awareness of developments and inspire to deliver improved inpatient diabetes care”.

The programme included talks from diabetes clinical leads from England, Scotland, Wales and Northern Ireland.the 5th National Diabetes Inpatient Conference

Healthcare professionals who have successfully implemented a per-operative diabetes pathway also spoke and there was also a session on preventing and managing inpatient diabetic foot disease.

Speed presentations on inpatient diabetes care also took place throughout the day.

Here is a summary of the abstract posters which were presented:

Name of poster abstract
The successful use of online learning to improve insulin prescribing practice in foundation year zero doctors
Lead
Robert D’Arcy
Name of involved organisations
Belfast Health and Social Care Trust and the Queen’s University Belfast
Conclusion
This structured case based e-learning module has demonstrated a significant improvement in insulin prescribing accuracy among FYO students. It is hoped that this will translate to improved inpatient insulin prescribing and glucose management for hospital inpatients as these students enter clinical practice.
Name of poster abstract
Inpatient Diabetes Education through Animation: IDEA as an adjuvant teaching tool to improve inpatient diabetes care quality
Lead
Sowmya Gururaj Setty
Name of involved organisations
University Hospitals of Leicester
Conclusion
We developed short (3-4 min) animated videos, based on frequently reported errors and cases of significant harm, as an adjuvant teaching tool for trainees and other staff members to improve quality of care for inpatient with diabetes. The videos are based on real life scenarios, with a focus on the safe use of insulin and include learning outcomes with key educational messages. The initial feedback is very positive with >3000 views till date. IDEA platforms include YouTube, INDIE, Vimeo and twitter.

IDEA is a unique and appealing model which can be used to easily disseminate focused and memorable top tips on inpatient diabetes safety issues to a large numbers of staff. We acknowledge that further evaluation will be required particularly with respect to acquisition and retention of knowledge and sustainability.

Name of poster abstract
Daily consultant-led diabetes ward rounds of acute medical and emergency department patients reduces length of stay
Lead
Elaine Hui
Name of involved organisations
Northwick Park Hospital
Conclusion
Our results showed that consultant-led acute diabetes WR reduced LOS on average by 2.07 days per patient which saved 2741 days of bed occupancy (= 2.07 days x 1324 patients) in the 3 month period.

Currently we are findings ways to provide a sustainable service with daily specialist cover and working with the information department on auditing other measurable outcomes.

Name of poster abstract
A Quality Improvement Approach to Improving Hypoglycaemia Management
Lead
Joanne Kerins
Name of involved organisations
Western General Hospital and Lothian Analytical Services
Conclusion
There have been 3 phases of work to improve the management of hypoglycaemia in the Western General Hospital (WGH) working parallel to the Diabetes: Think, Check, Act project. Using quality improvement methodology, linked glucometer data, staff education and performance feedback to a 30 bed ward, phase 1 demonstrated an improvement in appropriate hypoglycaemia management from 40 per cent to over 80 per cent of episodes.

Phase 2 focussed on a wider inpatient area (100 beds) using similar interventions, with the exception that there was no data feedback to wards on performance. This resulted in a 50 per cent improvement in appropriate hypoglycaemia management.

The first 2 phases of work highlighted the importance of automated generation and presentation of linked glucometer data to ward areas, to help drive improvement, change, and sustainability.

Through the diabetes dashboard data, the 3rd phase has demonstrated that the percentage of linked glucometer readings without patient CHI, is lower in 6 intervention wards (average 5% per cent) than the WGH site overall (11.9 per cent) and NHS Lothian overall (32.5 per cent) in March 2016.

Name of poster abstract
Reducing recurrent hypoglycaemia by using Point Of Care Testing (POCT) data
Lead
Preethi Nalla
Name of involved organisations
University hospital of Wales
Conclusion
At 3 weeks, a total of 132 hypoglycaemic events (78 on medical wards and 54 on surgical wards) were identified; A majority (77 per cent) of the hypoglycaemic events were mild (CBG, 3-4mmol) and 20 per cent were moderate (CBG between 2 and 3 mmol). A few patients (3 per cent) had CBG <2mmol.

The majority (38 per cent) of the hypoglycaemic events happened between 06.00 and 08:00 hours, reflecting a long gap between the meals. In conclusion, we noted a significant reduction (80 per cent) in recurrence of hypoglycaemia with this proactive, multifactorial, IT-supported, paperless inpatient service.

Name of poster abstract
Ward-based management of abnormal capillary glucose levels using Quality Improvement methodology- a multi-disciplinary team approach
Lead
Dipesh Patel
Name of involved organisations
Royal Free NHS Foundation Trust
Conclusion
Our measures include target time to hyperglycaemia control within 6 hours and hypoglycaemia control within 30 minutes. We were able to demonstrate improvements in both hyperglycaemia and hypoglycaemia management.

Current data demonstrates “time to control” in patients with hyperglycaemia increased to 81 per cent (of patients within 6 hours compared to 60 per cent at the start of pilot. “Time to control” hypoglycaemia in patients has increased to 70 per cent within 30 minutes compared to 0 per cent at the start of pilot.

There has been a 95 per cent reduction in “unknown” patient identifier glucometer codes used on the ward, ensuring better data quality and tracing of patients.

Name of poster abstract
Learning from NCEPOD: the ongoing challenge of improving diabetes care in vascular patients undergoing lower limb amputation
Lead
Eliza Davison
Name of involved organisations
Newcastle Medical School, Newcastle University; Northern Vascular Centre, Freeman Hospital; Newcastle Diabetes Centre and Freeman Hospital
Conclusion
Despite implementing staff education initiatives and new surgical ward guidelines, the quality of diabetes care in LLA patients did not improve and opportunities to obtain specialist input were still being missed. There appeared to be a disconnect between blood glucose monitoring and subsequent action taken, possibly due to inconsistent face-to-face leadership for junior medical staff on surgical wards.

An in-reach diabetes nurse service has since been established to provide consistent daily support to all ward staff. E-record prescribing prompts and automatic DSN alerts for recurrent hypoglycaemia are also being investigated as additional means of reducing medication management errors.

Name of poster abstract
Can assessment of hyperglycaemia in emergency hospital admissions help detect undiagnosed diabetes – a retrospective audit over one year?
Lead
Sandip Ghosh
Name of involved organisations
University Hospitals Birmingham NHS Foundation Trust, Gloucestershire Hospitals NHS Foundation Trust and University Hospital Waterford
Conclusion
This preliminary analysis of routinely collected, clinical data indicates that HbA1c estimation could be used for the diagnosis of undiagnosed diabetes in acute medical admissions as 63 per cent of those with APG ≥7.8 and 43 per cent with APG ≥11.1 mmol/L were not diagnosed with diabetes.

Turnaround time for HbA1c estimation may be an issue in some hospitals presently but this could be overcome by issuing a separate diagnostic code for HbA1c.

Name of poster abstract
Improving In-patient Diabetes Care in Scotland – the Diabetes, think, check, act project
Lead
Stuart Ritchie
Name of involved organisations
Information not supplied
Conclusion
Diabetes think, check act has shown improvement in demonstrator sites through better hypoglycaemia management and patient identification, with a reduction in observed insulin error rates. Further work is ongoing to promote spread and sustain improvements.

In the first 9 months of launch there have been 7000 elearning module completions.

Name of poster abstract
Improving inpatient diabetes care: whole system transformation
Lead
Rustam Rea
Name of involved organisations
Oxford Centre for Diabetes, Endocrinology & Metabolism, Oxford University Hospitals NHS Foundation Trust
Conclusion
The result of this has been a consistent improvement in a range of diabetes metrics since the start of the project in 2012.
Name of poster abstract
Diabetes Care in a Cancer Hospital
Lead
Louise Hopewell
Name of involved organisations
The Christie Hospital NHS Foundation Trust
Conclusion
The DSN provides expert clinical diabetes knowledge within a flexible and accessible service .Daily ward rounds are conducted .Medical and nursing staff are supported and educated to implement safe and evidenced based diabetes care.

A comprehensive diabetes management policy is available and compliance with the policy is audited and non-compliance addressed. Between Jan 2015 – Sept 2015 1751 patient reviews occurred. The DSN has supported staff to challenge their thinking and change practice. In turn this has improved diabetes care in a Cancer Hospital.

Name of poster abstract
Greater illness severity does not predict the occurrence of steroid-induced diabetes in acute medical admissions
Lead
Mohamed Elhassan
Name of involved organisations
King’s College London and King’s College NHS Foundation Trust
Conclusion
Inpatient SIDM does not reflect greater illness severity but SIDM was associated with a longer length of stay. Unexpectedly, illness severity in A&E was lower in those who went on to develop SIDM. Anthropometric variables that are not routinely captured, such as body mass index or waist circumference, may prove to be better predictors of SIDM.
Name of poster abstract
Greater illness severity does not predict the occurrence of steroid-induced diabetes in acute medical admissions
Lead
Mohamed Elhassan
Name of involved organisations
King’s College London and King’s College NHS Foundation Trust
Conclusion
Inpatient SIDM does not reflect greater illness severity but SIDM was associated with a longer length of stay. Unexpectedly, illness severity in A&E was lower in those who went on to develop SIDM. Anthropometric variables that are not routinely captured, such as body mass index or waist circumference, may prove to be better predictors of SIDM.

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