Summary
IDEA (Inpatient Diabetes Education through Animation) is intended to improve inpatient diabetes care. A review of serious diabetes incidents and DATIX incidents was used to identify recurring safety themes. These were then incorporated into a suite of animations. The innovation is aimed at delivering key safety messages to healthcare professionals (HCPs) in memorable bite-sized (3-4 min) animations. IDEA may be used to disseminate key learning messages to all HCPs who care for patients who have diabetes and are admitted to hospital. The videos focus on key areas identified where mistakes have been made, with the aim of learning from these experiences, improving care and patient experience. IDEA can be found on a variety of platforms to widely disseminate shared learning.
Results
IDEA videos were shown to a group of doctors and pharmacists as a pilot project. Feedback was very positive with 89% respondents scoring four or higher (range 1(poor)-5(excellent)) in evaluation. Around 94% of doctors in training (n=19) rated IDEA relevant, 83% rated useful and would change practice. Pharmacists (n=17) rated IDEA useful and relevant (94%) and would change practice (76%).
Challenge
The National Diabetes Inpatient Audit (NaDIA) in 2013 showed that up to 25% of inpatients have diabetes of whom ~40% are on insulin therapy. For the majority (> 90%) of these admissions diabetes is a secondary diagnosis and not the primary reason for admission and hence often cared for by non-diabetes specialty teams. NaDIA has highlighted sub-optimal care quality across several areas of inpatient diabetes care. Despite emphasis on the need to develop knowledge and skills in managing complex medical conditions including diabetes, there is a lack of confidence and knowledge among trainee doctors in managing inpatients with diabetes. NaDIA 2015 data for Leicester Royal Infirmary showed that on the day of data collection there were 129 patients with diabetes in hospital and of those 27.5% patients reported at least one episode of mild hypoglycaemia, 14.8% at least one episode of severe hypoglycaemia and 26.9% experienced an insulin medication error.
Objectives
To develop an innovative teaching tool for doctors in training which incorporates key safety themes taken from analysis of real-life incidents affecting inpatients with diabetes. To make the tool accessible to all, memorable, produced within a fi nite budget and easy to disseminate.
Solution
Analysis of serious untoward incidents (SUI) and DATIX incident reporting of inpatient diabetes/insulin errors from Nov 2013 to Oct 2014 was undertaken. A survey of sub-consultant grade trainee knowledge was also carried out. Recurring diabetes errors and safety themes (medical, nursing, dispensing and administrative) and areas of sub-optimal knowledge in inpatient diabetes care were identified. A robust pathway for reviewing DATIX errors within monthly diabetes morbidity and mortality meeting was implemented. Recurring themes were identified. Discussion within the multidisciplianry team nurtured a culture in which reporting clinical incidents and shared learning are is openly encouraged. A series of real life scenarios were selected to illustrate common preventable harms and animations - IDEA (Inpatient Diabetes Education through Animation) - were created around these scenarios to be used as an adjuvant teaching tool for doctors in training and other staff members (nursing and pharmacy) to improve quality of care for inpatients with diabetes and in turn improve patient safety and experience. These are short (~4 min) videos hosted on IDEA YouTube channel (https://goo.gl/SD56kY), IDEA Vimeo (https://vimeo.com/album/3947654) and also feature on Twitter @IDEA_UHL. They are also incorporated into an interactive web-portal INDIE (http:// leicesterdiabetescentre.org.uk/INDIE) which provides a platform for doctors to undertake a short self-assessment (10min) using modified pre-validates questionnaire to identify knowledge gaps and provides easy access to educational resources (links to educational material, IDEA videos and guidance).
Learnings
IDEA appeals to the current generation of trainees who are training in a culture of technology and bite size information delivery. The animations are easily viewed on either smartphone, tablet or PC. The rating we have received from medical and other staff members on the usefulness and relevance of these videos is excellent. The pilot suggests that ~80% of IDEA viewers report it would change their practice. This initiative will also show that the IDEA can be easily adopted by more than one Trust.
Evaluation
IDEA was evaluated in the 'real world' setting as teaching tool during trainee teaching sessions on insulin safety and inpatient diabetes care. IDEA videos were used to explain topics alongside conventional teaching tools like power-point/prezi slides/frames. The evaluation took place between April 2015 and Nov 2015 and was undertaken with groups of FY1s and Specialist registrars (ST3 and above). Around 98% of Specialist registrars (n=41) rated the content of the teaching session 4 on a scale of 5 and 95% of FY1s (n=36) rated the content of teaching with IDEA videos 4 on a scale of 5 (1= strongly disagree, 2= disagree, 3=Unsure, 4 =Agree, 5=Strongly agree).
