Background
An audit was carried out investigating the prevalence of diabetes in nursing homes in North Cumbria. The programme addressed the needs of nursing home residents with diabetes and all the staff of the nursing homes involved in their care. The training was provided on site in each nursing home.
Start date: March 2001
End date: March 2002
Objectives
· To raise awareness of optimal diabetes care.
· To provide a training programme for the staff of nursing homes.
· To introduce a protocol of care for each home and establish a named link nurse.
· Develop evaluation criteria for demonstrating improvements in diabetes care.
Service Provided
Planning:
· A project team was set up.
· A time plan for 12 months was drawn up.
· A map, to establish the geography of the area and the siting of the homes was produced.
· Evaluation criteria was drawn up with the advice of the inspector of nursing homes.
· Introductory visits to nursing homes were undertaken to establish contact and discover individual needs.
· A training programme schedule was devised and sent to each home with advertising literature.
Delivery:
· Each trainee was sent a pre-course leaflet with details of training and a word search to stimulate interest.
· A rolling programme of three training sessions was established and delivered to each home.
Training Sessions:
1. Understanding Diabetes
2. Diet and Diabetes
3. A mop up session. This addressed specific issues for the home and its residents:
· Training sessions, as a package were delivered in every home.
· All staff were encouraged to attend.
· Certificates of attendance given to all staff who attended all three sessions.
· An Understand Diabetes information file was provided to each home in addition a Diet and Diabetes information file for each catering department of each home.
· Each home was provided with a new blood glucose monitoring meter (provided by Roche).
· Dates were arranged for link nurse meetings following completion of training.
Accountability
The project team - Consultant Physician, Diabetes Liaison Nurse, Dietetic Manager, North Cumbria Acute Hospitals Education and Training Manager.
Markers of change developed as evaluation criteria.
Project Aims
More effective monitoring and recording of blood glucose results.
Being aware of impending problems and dietary needs.
Knowing when to ask for help.
The role of the link nurse remaining established.
Evaluation
The link nurses are still in post 18 months on.
Quality assurance testing for meters is still continuing.
Files of information being used.
Requests from cooks for further help.
Greater awareness amongst staff about diabetes care.
Good planning which identified and addressed the various barriers to learning, promoted an effective outcome. The training encouraged and promoted changes of work methods which facilitated improved diabetes care rather than just improving knowledge.
Update
The project was completed in March 2002.
Using the evaluation criteria from the project, developments and progress observed since the completion of the project include:
- Diabetes link nurses. 10 are still in post in the remaining 12 of the original 14 nursing homes. 2 homes have closed since the end of the project.
- Files of information. The two files -Diabetes Information for the nursing staff and Diet and Diabetes for the catering staff- that were given to each home at the end of their training, are visible in the homes and are still in use.
- Information leaflet. During the training, requests were received from the link nurses for an information leaflet that could be given to the relatives and friends of residents to encourage the receipt of appropriate gifts. The amounts of sweets, biscuits and cake were frequently causing problems with the glycaemic control of many residents.
A leaflet was produced during the second diabetes training project, giving ideas for non-food gifts. This was distributed to the nursing homes with agreement for them to reproduce more as needed.
- Blood Glucose Monitoring Training. Since the end of a second project in January 2004, on request from the nursing homes that wished for continuation of the diabetes training, further funding was received to deliver blood glucose monitoring update training.
- Blood glucose meters. Some of the meters, given to the homes by Roche, have been replaced during this training.
- Quality assurance. The homes are now doing their own quality assurance testing. Due to increased demand, the pathology lab at the Cumberland Infirmary, Carlisle has started to charge external organisations.
- In December 2002, twelve months after the completion of this nursing home project, funding was received to continue training in the residential care homes in the former East Cumbria. A new project was planned according to their different needs
Resources
Meters.
Material for information files.
Portable overhead projector.
Help from project team and medical illustrations department.
Blood glucose monitoring meters, support for study day and files for information provided. by Pharmaceutical companies.
Secretarial help.
Imagination.
Patience and good humour.
Funding/Costs:
A one-off payment of £20 000 from the Non Medical Educational Training Consortium.
Learning
Taking account of the factors in the individual work place before embarking on a training programme, help to make the training acceptable and at the right level. Achievable aims are essential in order to be successful.
Sustainability
There is a need to continue to provide contact and support to the homes.
Important to work alongside and with those requiring training.
Turnover of staff often very rapid necessitating a need to continue training and updating the changes in diabetes care.
Effective research and planning for the development of the training programme should not be underestimated.