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GIRFT diabetes report issues recommendations

By Editor
14th November 2020
Uncategorized

All trusts must have a dedicated multi-disciplinary team of specialist diabetes inpatient practitioners, according to a new NHS report.

The call is one of several recommendations outlined by the Diabetes GIRFT Programme National Specialty Report by Professors Gerry Rayman and Partha Kar.

Getting It Right First Time (GIRFT) is an NHS improvement programme delivered in partnership with the Royal National Orthopaedic Hospital NHS Trust and this latest diabetes report was published to mark World Diabetes Day 2020.

Trusts should work towards providing base-level specialist diabetes cover at weekends where this does not exist. Diabetes GIRFT Programme National Specialty Report 

Commenting on diabetes inpatient care, the report states: “We heard on our GIRFT deep dives that some trusts’ inpatient teams required further development, which is supported by 2017 NaDia data showing: One in six hospitals in England did not have a multidisciplinary foot care team; A quarter of hospitals did not have a single diabetes inpatient specialist nurse.

“Transformation funding since 2017 will have improved these figures, and the NHS Long Term Plan commitment for universal coverage of multidisciplinary foot care teams and diabetes inpatient specialist nurses will improve this further. This is reflected in our GIRFT recommendation.”

In response, the report said: “All trusts must have a dedicated multi-disciplinary team of specialist diabetes inpatient practitioners as indicated in the NHS Long Term Plan. Trusts should work towards providing base-level specialist diabetes cover at weekends where this does not exist.”

In scoping this report, the team identified the areas of diabetes care that need most attention and which offer the most significant opportunities for improvement. The team decided to focus ehir recommendations on three key areas, see below,

  • Type 1 diabetes
  • Inpatient care
  • Diabetic footcare

Other areas of interest will be addressed in other GIRFT reports, the 2020 report said.

List of recommendations Type 1 diabetes

Type 1 diabetes
Transition from paediatric to young adult services 

1. All trusts providing type 1 diabetes care should have a dedicated transition service with a clear pathway between paediatric and 16-18 services, a named lead clinician for 16-18 patients, and a service for 19-25 year olds. These services should provide support for those on insulin pumps and new technologies, as well as ongoing psychological support.

Training and technology

2. Access to diabetes technology should be available to all people with type 1 diabetes who need it in their local area in line with the NHS Long Term Plan and NICE guidelines. Relevant staff should be trained to support patients using these technologies and given the time they need to complete this training, which should form part of their annual appraisal process.

Structured education

3. All people with type 1 diabetes should be offered appropriate training to manage their condition through a QISMET-accredited, quality controlled structured education programme.

Systems to allow data download from blood glucose monitoring devices 

4. All trusts providing type 1 diabetes services should have a system, such as Diasend, to enable blood glucose data to be downloaded and presented in a meaningful way in all diabetes clinical areas – including paediatric, transitional, 16-18 and adult services as well as diabetes pregnancy services. Each department should have provision to offer virtual clinics to patients with type 1 diabetes. This should be supported by trust IT departments.

Inpatient care 
Dedicated multi-disciplinary inpatient diabetes teams (MDiTs) 

5. All trusts must have a dedicated multi-disciplinary team of specialist diabetes inpatient practitioners as indicated in the NHS Long Term Plan. Trusts should work towards providing base level specialist diabetes cover at weekends where this does not exist.

6. The MDiT should meet regularly to discuss day-to-day errors and safety issues, and report to a quarterly trust-level diabetes safety board which reviews the overall quality of the inpatient service, with support from IT, based on incident reporting, local and national audits of patient harms, diabetes medication errors, length of stay and readmissions.

Identifying diabetes on admission and ensuring rapid referral 

7. All trusts should have a robust system to identify all people with diabetes on admission to hospital, including emergencies and elective and non-elective surgery, and a triage system to identify those at risk and rapidly refer them to the diabetes team. This should be an electronic system, integrated with web-linked blood glucose meters which provide an alert system for staff when any out-of-range reading is recorded.

Reducing insulin errors

8. Training should be provided for every healthcare professional who dispenses, prescribes and/or administers insulin, appropriate to their level of responsibility, including an assessment of competency.

Improving care through perioperative pathways

9. All hospital trusts should have clear, audited perioperative pathways from pre-assessment through to discharge. These should be broadly in line with NCEPOD recommendations.

Supporting self-management in hospital 

10. All trusts should have and promote a self-management policy, which supports patients who want to self-manage their diabetes to safely do so while in hospital, as clinically appropriate and in line with wider NHSE and NHSI policies on inpatient self-management.

Diabetic footcare 
Effective diabetic footcare services 

11. All trusts should have a dedicated multi-disciplinary footcare service (MDFS) as stated in the NHS Long Term Plan and NICE NG19. The service should be well integrated with the community footcare protection service (FPS), and with hospital renal wards and dialysis units given the increased risk of amputation for diabetic patients in these areas. CCGs and STPs should ensure that community foot protection teams are trained to carry out foot screening and that the community service is structured to deliver the standards recommended in NG19.

Vascular networks 

12. Everyone with a diabetic footcare emergency requiring admission should be assessed the same day by the MDFS. If the MDFS identifies vascular impairment, they should have same day access to a vascular opinion, according to NICE NG19, whether the hospital is a vascular service hub or a spoke. If the MDFS is not present, the patient must still be assessed same day, which may require transfer to the vascular service.

Data and coding 

13. Local commissioners should build in clear contractual requirements for trusts to collect and submit data to the National Diabetes Audit, including data on type 1 patients aged 19-25, the National Diabetes Inpatient Audit and the National Diabetes Footcare Audit. Trusts should work to improve the quality and consistency of clinical coding.

Procurement and medicines optimisation 

14. GIRFT and partner organisations should work together to assess the financial and clinical case for novel approaches to the procurement of insulin pumps, blood glucose testing strips, oral anti-diabetic agents and diabetes footwear, which may reduce costs and support increased uptake of continuous glucose monitoring and closed loop technology. This should be done in a way that maintains reasonable choice for people living with diabetes.

Reducing the impact of litigation 

15. Reduce litigation costs by applying the GIRFT Programme’s five-point plan.

To access the report, click here.

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