Summary
The National Diabetes Inpatient Audit (NADIA) 2010 found that on average, people with diabetes account for 15 per cent of hospital admissions1.
The majority of day-to-day management of these patients is often assigned to nursing and junior medical staff that may feel ill equipped to deal with the challenges posed.
A survey conducted in the UK in 2008 found that only 28 per cent of post-graduate medical trainees felt fully confident in diagnosing diabetes, and 55 per cent and 49 per cent felt fully confident in treating hypoglycaemia and DKA, respectively2.
Confidence was also found to be low in starting intravenous insulin, titrating intravenous insulin, prescribing intravenous fluids and changing diabetes regime.
In 2010, the NADIA reported that diabetic in-patients on insulin had poor glucose control and common problems identified included errors in insulin prescribing, insulin administration and the use/misuse of insulin infusions1. In addition, many patients reported disempowerment in terms of being allowed to self-manage their diabetes care1.
Results
We compared the NADIA audit findings before and after the introduction of this DMEM and found that inpatient care has improved significantly one year after the introduction of the DMEM.
In addition junior doctors were surveyed on their experience and their confidence in managing diabetic inpatients greatly increased as a result of the e-learning experience.
Challenge
These findings highlight the need for improved education and training for post-graduate doctors in diabetes management in hospitals.
However, with expansion in junior doctor numbers over the last decade and reduced time for face-to-face teaching – the result of changes to the European Working Time Directive – new teaching methods are required to meet the challenge of educating and training junior doctors in the modern NHS.
E-learning and web-based education have been widely used to provide effective, accessible and interactive forms of teaching in many disciplines. By encouraging the learner to play an active part in their education, e-learning may promote better retention of information and utilisation of skills3.
Solution
Barnet & Chase Farm NHS Trust has introduced a Diabetes Management E-learning Module into the induction programme for junior staff at two sites including 700 in-patient medical/surgical beds.
The Diabetes Management E-learning Module was launched in October 2010 and includes interactive web-based teaching on aspects of inpatient and emergency treatment of diabetes.
Having completed the DMEM, junior doctors completed a 20-question MCQ exam online (for which a pass-rate of 100 per cent has been set); they received a certificate as confirmation of completion of training.
