Download - Diabetes… Improving Inpatient Care
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Diabetes…Improving Inpatient Care
Dr Mayank Patel BM DM FRCP
Diabetes & Acute Medicine Consultant
University Hospital Southampton
May 2018
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My disclosures
I have received honoraria for speaking at meetings from:
Eli Lilly & company
Sanofi
Novo Nordisk
MSD
AZ
Mylan
Boehringer Ingelheim
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Who am I?
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Delivering Inpatient Diabetes Care:Aims of talk
• To present some guiding principles based on my local experience and learnings from elsewhere
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Inpatient Diabetes:setting the scene
• Majority of patients with diabetes are not admitted for diabetes reasons
• Majority of patients are under the care of a non –diabetes clinical team
• Diabetes: Destabilised by acute illness and hospital interventions
• Diabetes medication errors, especially with insulin, have harmed patients
• There are some knowledge gaps around ‘basic’ diabetes among HCPs , which can increase clinical risk
• 10% of national inpatient spend in hospitals is on diabetes
• 1 in 3 - 1 in 5 adult inpatients in UK hospitals have diabetes
• 1 in 4 UK trusts have no inpatient diabetes team
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How is the inpatient diabetes experience in my hospital?
• Patient experience?
• Risk?
• What’s the temperature? Is there appetite for development?
• Tools that can help:– NaDIA report
– CQC
– Complaints
– Diabetes reported adverse events
– Patient stories
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Inpatient diabetes: where to start?
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A roadmap...
• Admission
• During Admission
• Discharge
• ‘marginal gains?’
• There is no single toolkit to solve it all….
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Diabetes: The flight analogy…
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Welcome to NHS airlines…
• Have a safe flight?!
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Planning the trip…
• Primary care:
– Elective admissions (how is the diabetes control?)
– UHS: ‘PEGASUS’ (work with pre-assessment teams)
• Patients:
– Article (Diabetes Research & Wellness Foundation)
https://www.drwf.org.uk/news-and-events/news/diabetes-care-hospital
Or search: 'Diabetes care in hospital'
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Check in...Is your trust diabetes aware?
• Patient identification & Diabetes type? (IT/ documentation processes)
• Safe Prescribing (insulin) & Footchecks
• UHS: newly diagnosed Type 1 diabetes OOH pathway
• Staff training in diabetes
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In flight
• Cleared for take off…
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Examples of interventions at UHS
• To raise profile of ‘inpatient diabetes’:
– Worked with other departments (e.g. oncology, vascular, cardiac, pancreatic surgery) to raise diabetes awareness, Link nurses etc
– Full MDT ward rounds: ‘a visible presence’
– Inpatient Diabetes elearning resource
– eReferral system
– Networked point of care BG meters
• Set up alerts for early notification of dysglycaemia
– Set up alerts for early notification when ‘at risk’ patients admitted
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During the flight…
• Ensure patient is aware of impact of admission on diabetes (‘in flight reading?’)
• Ensure BGM occurring
• Involve diabetes team if needed (only 40hrs/wk?)
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It was all going so well…
• Turbulence?
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‘Glucose encounters of the absurd kind...’
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Glucose encounters of the absurd kind:The challenges...
• BGLs not on Early Warning Scores…
• Need to educate (specialist v non-specialist diabetes responsibilities)
• More than 40hrs in a week
• Need to encourage ownership of the issue (‘all grades’)
• How to inform and support ‘at scale’?
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2016: MicroGuide DiAppBetes
• Advises on things the diabetes team take for granted!
• Free to download
• Option for other Acute trusts to bespoke the content for their own needs
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App Screenshots (1)
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What might support a better inpatient diabetes future?
• An appropriately resourced diabetes team
• Leadership, enthusiasm and persistence from diabetes teams
• Teamwork & patient stories
• Make the case, generate data, cost it
• Drivers for change: LoS data, error rates, complaints, executive and stakeholder support, financial savings
• Create a ‘diabetes friendly’ workplace culture
• Taking ideas from all corners – staff, patients, execs etc
• Mandatory training in diabetes for all?
• (Diabetes UK: Shared practice library)
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In conclusion:Inpatient Diabetes
• The brand of inpatient diabetes is well established
• A National issue with no single solution, but Local initiatives and Local leadership and enthusiasm is ESSENTIAL
• People with diabetes have died in UK hospitals through errors in care – learn from errors
• IT is a key enabler
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Thanks for listening