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Regional Innovation Fund 2010/11 Project: LTC 20013

Implementation of the ‘’Think Glucose’’ initiative across Leicester Hospitals

University Hospitals of Leicester NHS Trust
This Regional Innovation Fund project will ensure the speedier roll-out of the ‘ThinkGlucose’ quality and safety innovation programme, raising awareness of the specific clinical needs of diabetes inpatients.
Providing individual ward based audit, diabetes education and patient satisfaction surveys, it will support clinical staff to provide quality care for inpatients and reduce length of stay.
Healthcare professionals at ward level will have a greater understanding of the specific clinical needs of diabetes inpatients through the use of patient and staff audit, and nurse-led education by diabetes specialists.
Staff on 30 key wards in the Trust will benefit from bespoke training on insulin management, with provision of hypo boxes to the remaining 70 wards to ensure that the care of all patients is improved, as part of the expedited rollout of the NHS Institute for Innovation and Improvement’s (NHSIII) ‘ThinkGlucose’ programme.  
Without additional funding this project would have taken more than three years to fully implement, and now will be delivered in the twelve months between April 2011 and April 2012.
People with diabetes who are admitted to hospital stay twice as long and are twice as likely to be admitted as those without diabetes. The National One-Day Audit of Diabetes Inpatients (November 2010) revealed a bed occupancy rate of 14.9% (University of Leicester Hospitals) compared with 15% nationally.
Prescribing and management errors increase the length of stay for diabetes inpatients which can lead to further complications e.g. hospital acquired infection or pressure sores.
Local prescribing and diabetes management errors identified in the 2010 one-day audit were higher at 47% in Leicester hospital sites as compared to 37% nationally.
Diabetes UK reports that diabetes inpatients are generally dissatisfied with their inability to self-manage and frequently report problems around staff knowledge.
‘’ThinkGlucose’’ implementation to date showed that 52% of staff had not received any diabetes education for five years or more. Case note audits revealed:
  • 90% patients had no diabetes care plan
  • 75% did not have a foot check documented during admission
  • Blood glucose monitoring had not been done as required in care standards
These were common errors relating to mismanagement or prescribing of diabetes medicines.
Expedited rollout of the “ThinkGlucose” programme across 30 wards at University Hospitals of Leicester NHS Trust designed by the NHS Institute for Innovation and Improvement (NHSIII) to reduce health inequalities, variations in care delivery and support the delivery of a clinical pathway that improves the management of inpatients with diabetes as a secondary diagnosis. 
This initiative raises awareness with healthcare professionals at ward level about the specific clinical needs of diabetes inpatients through the use of patient and staff audit and diabetes specialist nurse-led education.
The process for each ward recruited to “ThinkGlucose” consists of:
  • Engagement with ward managers and appointment of ward based “Think Glucose Champion”
  • Staff knowledge questionnaire: completed pre and one month post-intervention
  • Medical notes audit where 20 sets of notes are randomly selected and audited on nursing care.
  • Ward-based training using frequently delivered 15-20 minute teaching sessions and covering various aspects of diabetes care topics, processes and guidelines. Eighty percent of ward staff are expected to complete the modules
  • Use of patient satisfaction questionnaires
  • Developing leaflets for people with diabetes to receive when they arrive on the wards.
  • Information posters, Identification-type cards with referral criteria and prompts for foot checks, Insulin profile A5 posters, prompt for effective use of variable rate insulin infusions. Re-audit- length of stay, medication errors, referral rates.
  • Identification of a ward-based “ThinkGlucose Champion” for each ward.
  • Ongoing diabetes update and addressing of educational gaps through effective communication links with the “Think Glucose Champion”
This project provides individual ward-based audit, diabetes education and patient satisfaction surveys and supports clinical staff in the provision of quality care for diabetes inpatients and reductions in length of stay
This initiative is patient centred; it ensures that there is effective staff training in diabetes and leads to:
  • Improvements in the patient experience and satisfaction
  • Increased patient safety by reducing the risk of medical error
  • Improved quality of care
  • Reduces lengths of stay for patients
  • Enables diabetes inpatients to self-manage their condition where clinically appropriate
 
  • Promotes effective communication channels and information sharing
  • Enables ward-based audit
  • Improved staff awareness of diabetes
  • Improves staff knowledge and competencies in a setting familiar to the staff
  • Leads to improved staff satisfaction and confidence in managing diabetes
  • Staff concerns can be dealt with at ward level in a timely manner
  • Improved partnership working between the ward staff and the diabetes specialist team
  • Enables future workforce planning as can match service provision to design by reducing inappropriate referrals.
  
  • Implements effective referral processes and through this, ensures the best use of resources including workforce
  • Enables best clinical practice which can lead to earlier patient discharge
  • Ensures patients are referred / signposted in a timely manner to other specialties according to clinical need e.g. vascular surgeons, podiatrists, dieticians.
  • Ensures appropriate patient coding
  • Will assist the Trust in achieving meeting regional Care Quality and Innovation (CQUIN) targets (4 and 5)
The local ‘’Think Glucose’’ pilot revealed a 53% reduction in inappropriate referrals and audit data collected I year prior to and 3 months after the pilot phase showed  diabetes medication errors were also reduced from 3 to 1. The coding of patient was also found to be more effective which assisted the Trust in ensuring they received the correct tariff payment
A single day inpatient stay on a general medical ward is estimated to cost £285. The National One Day Inpatient Audit carried out in over 200 UK hospitals in November 2010 revealed 213 diabetes inpatients in Leicester Hospitals on the day of audit. If each of these people had their length of stay reduced by only one day the trust would have ‘saved’ £60,705.  This was only one day’s data, the NHSIII estimates that if ThinkGlucose was implemented across the whole of one Trust and the average diabetes length of stay was reduced by at least two days, this would result in cost reductions in the region of £1m per annum to the Trust.
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Contact the Innovator

June James, Helen Atkins & Judith Spiers, University Hospitals of Leicester NHS Trust

june.james@uhl-tr.nhs.uk

judith.spiers@uhl-tr.nhs.uk

Helen.Atkins@uhl-tr.nhs.uk

 

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Documents to Download

See the project featured in the East Midlands Regional Innovation Fund Projects Brochure on Page 49

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