Intended Audience
User group, health care professionals and stake holders
Health Area
Dartford and Gravesham NHS Trust, West Kent PCT
Background
To provide a comprehensive service to children and young people with diabetes, so that they can easily access to a user group friendly, closer to home, child led, NICE and NSF standards compliant service in the district
Why this service is a good example of shared practice
Due to the service improvement mentioned above, the service brings a successful consortium between user group and service provider, with a high satisfaction rate among user group
Service Provided
- Up to date guidelines on various aspects of diabetes are widely available and easily accessible via hospital intranet to all hospital staffs and via internet to public.
- Change in the work culture by initiating child and family led service
- Introduction of a number of specialist clinics to cover various aspects of care:
(1) Weekly one stop multi professional clinic – The appointment is of 30minutes where all relevant professionals i.e. paediatric diabetes consultant, paediatric Diabetes Specialist Nurse (PDSN), paediatric dietitian sit together, with the facility of HbA1c in the clinic. Height, weight, blood pressure are monitored and injection sites are checked. It is consultant supervised but child led clinic; child and family decide the subject for their discussion rather than professionals. As it is one stop clinic it unifies the opinion of professionals and has a very high satisfaction rate of user group as well as professionals since the clinic start running from late 2003. This service is delivered without any extra recourse of funds, with a DNA rate of about 7%.
(2) Annual multi professional clinic – The appointment is of an hour and half and is a nurse led but consultant supervised service. It is run by PDSN along with dietitian, retinal photographer, podiatry and pathology department for various investigations. To minimize the DNA rate in the clinic, a second reminder is sent to all patients one month before their clinic appointment. The service is run on the third Monday of each month and it is a whole day clinic. All screening and tests are carried out and patients will have results sent to them in a letter following the appointment. The DNA rate of this clinic is less than 2%.
(3) Quarterly Joint Transitional clinic – These clinics are held for adolescents who will be transferred to the adult clinics from the paediatric care, time of transfer is usually around the age of 16 years. In order to minimize any kind of intimidation among clinicians and nurses, two teams are working together in this clinic. The set up is also aiming to improve the handover for clinical information of patients to the whole team: Team A has paediatric diabetologist and adult diabetic nurse, while Team B has adult diabetologist and PDSN. The process of transition is discussed with the adolescent and their families as early as possible in children’s diabetes clinic; they were also given choice for timing of their transfer. This clinic runs 4 times a year and approximately 4-6 patients are seen at each clinic session (maximum of 8). The handover letters were written at the last clinic attendance of these children in children’s diabetes clinic. The clinic is purposely kept in the afternoon (4-6pm) in order for the adolescents to maintain their school attendance on the day. Each of them has a 30 minutes slot and the DNA rate in the clinic is less than 2%.
(4) ‘Open Passport’ System – children and their parents can have access to support at any time of any day. During office hours Diabetes Paediatric Nurses are available to make home visits and can be accessed by telephone, email and text servicing. At weekends and evenings, children can speak to the staffs on call or visit the paediatric ward in the hospital.
Accountability
Work has been assessed regularly in NSF paediatric subgroup and NSF hospital implementation group meeting. The team has been participating in National electronic diabetes audit under National Clinical Assessment Authority (NCAA) from its inception of year 2004, and also average HbA1c is comparable to the national average. The team has been carrying out various audits and survey to compare the local practice with national standards/ nationally agreed guidelines, and it is found to have acceptable to an excellent service in all the aspects of the care. Three articles were published based on local practice in international journal “Paediatric Diabetes” reflecting high standards of current practice for local diabetic population.
Resources
Reorganization of the same resources for:
- Creating a dedicated children’s diabetes team with input from doctor, nurse and dietitian.
- Following a discussion with adult diabetes team, have a planned handover to them for young adult users.
- Regular meeting with representatives of user group and carrying patient’s survey
- Formulation of guidelines and protocols in order to share the information on intranet and internet.
Additional resources for:
- Regular and mandatory attendance of members as part of their continuing medical education to various teaching, education meetings, conferences and courses
- A funding for Electronic Patient Record (EPR) from the Dartford and Gravesham NHS Trust in year 2004. Since then the team have been maintaining paperless record for all outpatients’ activities for diabetes patients. The system is also used by adult diabetes department so this makes a very effective way of handover and sharing of records by all professionals
Learning
To run any successful and effective service in the community, it is essential that both the users and health care professionals can actively co-ordinate together to achieve the common goal, agenda and strategy.
Sustainability has been achieved in the last 4 years with an appointment of a lead clinician for diabetes in children, also the support from the trust, local PCT, colleagues from adult and children diabetes team.
Additional Information
In order to provide services for children on insulin pumps and basal bolus regime, the team has acquired knowledge and skills by attending appropriate courses and training in various insulin regimes.
The team won the best team award in the trust 2007 and recently nominated by various people including patients for various categories in Best of Health Award (National and South East Coast).
Contact
Dr ALOK GUPTA
Dr ALOK GUPTA
Consultant Paediatrician & Diabetologist, Children Resource Centre, Darent Valley Hospital, Dartford, Kent, DA2 8DA. Tel: 01322428752
Email: alok.gupta@dvh.nhs.uk
Mr CRAIG TICEHURST
Children’s Diabetes Nurse, Children Resource Centre, Darent Valley Hospital, Dartford, Kent, DA2 8DA. Tel: 01322428473.
Email: craig.ticehurst@dvh.nhs.uk