Proactive Ward Round in Luton June 2008
16 June 2008
Intended Audience
Inpatients with Diabetes, nursing and medical staff
Health Area
Foundation Trust Hospital - Medical and Directorate of medicine for the elderly (DME wards)
Background
People with diabetes are admitted to hospital twice as often and stay twice as long as those without diabetes. Diabetes NSF standard 8 on Hospital Admission states Trust needs to:
· Provide guideline drive care
· Ensure diabetes is monitored
· Encourage individuals autonomy
· Provide support to manage their own Diabetes
· Provide appropriate food and snack choices
· Provide key interventions: to have better liaison between ward staffs and Diabetes team; and adherence to diabetes management during surgery
How this service improves
- Instead of wait for late and missed referrals, the team identify people with diabetes proactively on wards and those requiring input for management
- Improve glycaemic control of in-patients with diabetes
- Increase awareness of diabetes team role on wards and source of education for healthcare professionals.
- Prevent delays in discharge and reduce length of stay
- Education opportunity for staff and people with diabetes
Why this service is a good example of shared practice
It enables an early identification of inpatients with diabetes and/ or with poor glycaemic control. Proactive management of this can also prevent further complications by improving management of glycaemic and encourage early discharge. In addition, the approach of having Diabetes Specialist Nurses (DSN) visit to the wards twice weekly provide a good opportunity to make education and support available to ward staffs and raise the profile of roles of the diabetes team.
Objectives
Ward round carried out initially in the 10 medical, DME, surgery and Acute Care Unit wards. The ward round are undertaken daily between 8am-9am. DSN use ‘Ward Referral’ and ‘List of people with diabetes admitted’ forms to enter initial data. People with diabetes are identified on ward board with a red dot until bedside individuals identification is in place. DSN will enter instructions on drug chart, medical notes and Diamond if required. Discharge summary will include changes to drugs, if people with diabetes have not been referred to consultants or returning to diabetes mellitus clinic for a follow up. In events of risk incidents, assess if existing protocols/guideline are in place to prevent recurrence of similar type of incidents.
Service Provided
Each medical and DME ward are visited on a twice weekly basis by the band 7 Diabetes Specialist Nurse (DSN).
Services provided including daily ward round by band 7 diabetes specialist nurses to triage all known individuals with diabetes and as risk individuals (e.g. individuals on steroids or Percutaneous Endoscopic Gastrostomy feed). Drug and blood glucose chart are examined for type of treatment, enteral feeds and steroids as well as blood glucose readings. If blood glucose are outside the agreed targets, DSN to advice nursing staff on management plan i.e. dose titration or addition of drugs, and review/ refer on as appropriate.
In events of risk incidents, the team assess if existing protocols/guideline are in place to prevent recurrence of similar type of incidents. These risk incidents could include: Largely prescribing errors; omitting doses; not following guidelines/ protocols correctly or at all. Action taken: To offer education to healthcare professionals such as providing more study days/ sessions; clinical supervision are given and to limit duties until they have reassessed; also to develop trust wide action plan to review and standardise protocols
The team also increase awareness of their roles among ward staffs by physical presence on the wards as well as records the action plan for individual’s treatment on Diabetes session of drug chart. This would in turn help complementing basic ward staff knowledge and skills in diabetes care and management.
Accountability
Diabetes Consultant
Project Aims
To identify all people with diabetes who are admitted in hospital thus meeting Diabetes NSF standards. To proactively identify inpatients with diabetes requiring input by diabetes team. To improve diabetes care by identifying risk and providing education support for staff, reduce errors and risks in future and improve individual’s safety.
Resources
DSN doing ward round of 10 medical and surgical wards with total of 6-7 hours a week
Learning
Hyperglycaemia was more a problem than hypogyceamia. People on steroids were highlighted as the most miss managed - this included both known and not known diabetes. This information helps putting inpatient glycaemic control on the Trust patient safety agenda.
Learning part for steroid management: to address identification of at risk people through random observation and then review on round, CCV 48 monitoring, trust wide identification, working with respiratory unit to identify people with diabetes, standardising treatment within diabetes team for management of people with diabetes.
The team is also piloting an Early Warning System for glycaemic control that would hopefully ensure that blood glucose out of target is acted upon promptly instead of waiting for DSN round on a weekly basis.
Additional Information
From a recent DSN ward round audit, 22% of the wards expressed that the DSN input was required.