Improving inpatient care for people with diabetes
at the Royal Berkshire NHS Foundation Trust:
The Think Glucose Project
Naseem Sohpal
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Introduction
• THINKGLUCOSE is a major new programme from the
NHS Institute
• Designed to improve the management of people with
diabetes in hospital
• Provides tried and tested products to improve
awareness and remove obstacles
• Promotes proactive care in those patients with
diabetes as a secondary diagnosis
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Issues Identified nationally
• Errors in the prescription and administration of insulin
• Inappropriate treatment of hypoglycaemia
• Limited Staff knowledge of diabetes
• Inappropriate referrals to the diabetes team
• Lack of early screening and communication
• The type and timing of meals
• Failure to involve people in the management of their diabetes
• Lack of a clear and established care pathway
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National Pilot Results
What increased
• overall quality of care
• patient safety
• bed efficiency
What decreased
• diabetes team utilisation
 insulin drug errors
• staff knowledge and awareness
 other adverse incidents
• patient satisfaction
• income (more accurate coding)
• staff satisfaction
• resource efficiency
 length of stay
 cancelled procedures
 complaints
 delays in discharge
 inappropriate referrals
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Our approach
Steering Group :
Executive level involvement
1.
2.
3.
4.
5.
Workstreams:
Assessment/Referrals
Patient Safety/Education
Patient Experience
Self management
Coding

Specialist Team involvement

Clear guidelines/protocols on hospital
intranet
Diabetes Champions on all wards
Individualised Care-plans
Discharge Plan of Care



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All patients with diabetes who are admitted into hospital will have
this assessment completed
Why?
RBHFT point prevalence study
revealed that only 9% of diabetic
patients who needed a referral
were referred
Easier for ward staff to determine
whether the diabetes team input is
required for individual patients
The referral tool will ensure that
referrals to the diabetes team are
appropriate and timely
It helps ensure that the diabetes
team are able to target their efforts
and focus their input on the
patients
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Since Think Glucose: June 2010
Referrals to the Diabetes team
CCU / CDU pilot
21/06/2010
200
Roll out - Medicine and
part Surgery, end August
150
100
50
2008
2009
2010
December
November
October
September
August
July
June
May
April
March
February
January
0
2011
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Some adverse incidents/errors
 Late referrals – discharge delays
 Incorrect use of syringes
 Misuse or mismanagement of IV insulin infusions
 Discontinuing IV insulin inappropriately
 Prescription errors- insulin omission or delays in insulin
administration
 Mismanagement of Hypoglycaemia
 Timing of food and insulin dose
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Role of Diabetes Specialist Team at the RBFT
 To review all appropriately referred inpatients – currently 150 -180 per month
seen by Diabetes nurses plus doctor ward rounds
 Diabetes nurses provide patient education and follow up support by
telephone helpline
 Advice and support to all staff eg. medication, insulin administration devices,
blood glucose monitoring, IV sliding scale
 Involvement in staff teaching eg pharmacy staff, Physiotherapy, Podiatry,
and Occupational Health on Hypoglycaemia management
 Involvement in Induction Programmes both doctors and nurses
 Supporting Ward teaching programme by Practice Development Team –
Thank you to the Practice Educators
 Development of Protocols and guidelines eg Sliding Scale Insulin and
Endoscopy leaflets for patients
 Appropriate Discharge Planning- using our Think Glucose Discharge Plan of
care
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How we measure Progress with Think Glucose
 Weekly ward audits on referrals
 Diabetes Nurses audit on number of appropriate referrals
 Diabetes nurses audit on date of referral to date of action
 Diabetes nurses audit on Discharge plan of Care
 National Diabetes Inpatient Audit - annually
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Further New Initiatives at the RBFT
 New Hypo Boxes in every ward and Department
 Patient Self management of Insulin in hospital
 Blood Ketone testing for patients admitted with Diabetic Ketoacidosis
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Hypo Box Contents:
The new Hypo Box
for all wards and
departments
3 x Glucojuice
1 x pack 20 lucotabs
2 x Triple Packs Glucogel
1 x Glucagon IM 1mg
(kept in ward fridge)
Treatment Record Book
Treatment pathway card
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Thank you
Any Questions?