New model of care developed for community diabetes nurses

By Editor
19th July 2021
Care planning, Nursing

A review into care delivered in the community to people with diabetes has led to the launch of a new model of care programme.

Medway Community Healthcare in Kent teamed up with Leicester University Hospitals and EDEN Healthcare Professional Training to look at ways to improve patient care, particularly among those who are housebound and may ‘slip through the net’.

The report, Community Caseload Review (Housebound Diabetes), highlights that an increasing number of people require help with managing their diabetes because they are unable to self-care or are care home residents relying on Community Nursing Teams to deliver insulin.

The COVID-19 pandemic saw an increase in those leaving hospital, new to insulin, and relying on community nursing teams to administer. With these teams facing growing caseloads, it is important that they are equipped with the skills to deliver the right care to people with diabetes.

Community nursing caseload reviews which have been carried out in recent years have similar findings – that many patients who have sporadic blood glucose monitoring are often experiencing episodes of hypoglycaemia in between community nursing visits.

This latest report identifies that in Medway Community Healthcare area, community nursing teams were supported with insulin administration by other specialist teams during the second wave of the pandemic in January 2021. This led to reviews of patients being highlighted as inconsistent and scant, with a number of errors reported between April 2020 and April 2021.

Now a new three-tier model of training for community nurses has been developed and is being piloted across the organisation:

Tier 1: Foundation diabetes training
Utilisation of The Diabetes 10 Training cards for all community nursing teams, which cover the 10 points of diabetes care within the community. The Diabetes 10 Point Training programmes are developed by Diabetes Nurse Consultant Ruth Miller and this has been adopted by Medway Community Healthcare.*

Tier 2: Advanced diabetes training
Eden CARES is a three-month comprehensive virtual online education programme consisting of a recorded lesson, three eLearning modules and a virtual group mentoring session.

A CARES programme is also being rolled out to care home staff along with community nurses, to help to increase the number of insulin competency assessments performed and sign offs completed.

Tier 3: Insulin Training and Delegation
NHS England led – awaiting launch date.

The report also highlights the role the Freestyle Libre Sensor could play in helping to reduce incidents of untreated hypoglycaemia, and suggests enhanced education through Eden Flash Glucose Monitoring eLearning.

The authors say “implementing the Tiered model of care will ensure that all of the community nurses are educated to a national level at each Tier, which in turn will give them confidence to delegate insulin administration to those Unregistered Practitioners working in care home or residential settings.

“Education will be key in enhancing knowledge and confidence for all those involved, which ultimately provides an opportunity for community staff that has engaged in the training to support others whether that be other community nurses, domiciliary and care home staff. With the ultimate goal being a positive impact for people with diabetes by improving their quality of life and safety, which could potentially reduce the risk for diabetes related hospital admission and reduce the financial cost to healthcare.”

The report’s lead authors are Sarah Gregory, Clinical Lead, Community Diabetes Team at Medway Community Healthcare and James Ridgeway, Education and Research Associate at University Hospitals, Leicester.

* The Diabetes 10 Point Training programme was developed to ensure that all staff in a ‘patient facing’ role in health and social care have a basic knowledge of diabetes. The training has been taken up by thousands of staff and has won awards and recognition for the improvement of patient safety.  There are 4 available programmes: Diabetes 10 Point Training for Inpatient staff, Diabetes 10 Point Training for Inpatient and Community Mental Health Workers, Diabetes 10 Point Training for Adult Social Care Workers (care and nursing home staff) and Diabetes 10 Point Training for Community Nursing Teams.  All programmes which will be RCN accredited will be available online later this summer – email ruth.miller2@nhs.net for more information.

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