Summary
A workforce that understands diabetes is fundamental to safe care. Staff across all health and social sectors share this responsibility. People with diabetes are living longer, many with multiple comorbidities and increasingly complex treatments. Yet diabetes is routinely managed by grassroots staff in different settings, many lacking access to training. Joining up knowledge across all sectors is essential to safe care, enhancing cross-organisational communication, care integration and patient outcomes. The Diabetes 10-Point Training (D10PT) offers focused, relevant training for hospital staff, mental health workers, community nursing teams, adult social care workers and community support workers.
Innovation
In 2017, the National Diabetes Inpatient Audit (NaDIA) reported that inpatients with diabetes had high levels of harm and mortality. At this time the project instigator was Clinical Diabetes Lead in an acute London Trust. The core recurring issues resulting in unsafe care and harm included: failure to listen to the person, their family or carer; insufficient training and diabetes knowledge, as well as not seeking specialist support. Concise, relevant training was needed for all staff, so the D10PT was developed for inpatient staff. The 10 points were: 1. the person: listen to the person they live with their diabetes 365 days a year; 2. know the difference between the types of diabetes; 3. feet; 4. hypoglycaemia; 5. hyperglycaemia; 6. how to prescribe and administer insulin safely; 7. how to manage a tube-fed person on insulin; 8. intravenous insulin; 9. diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS), plus 10. how to refer to the diabetes team and discharge safely. It became clear that staff in all parts of the pathway needed training, so D10PT was developed for mental health workers, community nursing teams, adult social care workers and community support workers (homeless service staff). People with serious mental illness (SMI) and learning disabilities (LD) experience significant health inequalities with high rates of diabetes, complications and premature mortality. Giving health and social care workforces diabetes training creates knowledge to bridge health and social care, improving cross-organisational communication and integration of care. In June 2022, the D10PT partnered with Cambridge Diabetes Education Programme (CDEP) to bring D10PT online with free access, increasing reach, scalability and resilience.
Equality, Diversity and Variation
Diabetes is inextricably linked to socioeconomic determinants. It can also negatively impact psychological and emotional health. A core aim is to reduce health inequality and improve health outcomes for the most vulnerable groups. People with SMI and LD experience significant health inequality and premature mortality. D10PT provides practical and pragmatic advice and information to identify problems and seek help without delay. From 2022 D10PT for mental health workers was adopted by South London and Maudsley NHS Foundation Trust (SLaM) and South London Partnership (SLP) as their core diabetes training. Training via online platforms was cascaded to the mental health workforce via the train-the-trainer approach. Face-to-face and cascaded education was given to staff in homeless hostels and third sector providers. D10PT aims to challenge negative stereotyping, increase awareness around language and reduce stigma. Working closely with a Partners In Diabetes group, resources were created for people with diabetes with content written by people with diabetes (PWD). D10PT offers online free, concise, high quality training and is timely and relevant in a climate of staff shortages, financial crisis and inadequate training budgets in health and social care. D10PT has been adopted outside the trust and local North West London ICS. Pre 2020, face-to-face training was delivered in North West London to 4,000 inpatient staff, 800 adult social care staff, 400 community nursing teams and 500 mental health workers. Since D10PT went online in June 2022, more than 2,000 staff outside North West London have accessed training modules. Further focused training is being developed with CDEP for groups including prison/police service, type 1 diabetes and disordered eating (TIDE) and midwives.
Results
Monitoring the impact of training has always been an essential part of implementing D10PT. Results include those for an acute hospital where more than 3,000 staff were trained between 2018 and 2020. NaDIA data in 2019 indicated significant safety improvements: medication errors down 38.3% to 7.3%; prescription errors down from 16.0% to 2.7%; glucose management errors down from 24.7% to 4.7%; insulin errors down from 24.7% to 4.7%; severe hypoglycaemia down from 10.4% to 4.2%. Online users provide feedback regarding knowledge, confidence and guideline familiarity. The e-learning offers focused learning based on the person’s role and who they support. Real-time results (as at early July 2023) showed that 65% of staff who started D10PT completed the training. Users can access training in bite-sized chunks to fit it into their busy lives, so staff are in the process of completing the training. However, the high average completion rate demonstrates that the majority find the training accessible and worthwhile.
User Feedback
User feedback is collected on CDEP following successful completion of topics or modules. Users complete evaluations that generate their certificates, ensuring 100% feedback. Users note current ability before starting online training and reevaluate at the end. Both questions utilise a five-point scale to standardise answers allowing robust audit of results. There are also qualitative questions to gain insight into user experience.
Dissemination and Sustainability
The D10PT was originally delivered face-to-face. This approach was limited, so the train-the-trainer approach expanded dissemination via nominated diabetes champions within services and across health and social care organisations. Finally, to maximise D10PT scalability and sustainability, D10PT was delivered online in partnership with CDEP, across the UK and beyond. Online training with inbuilt, robust assessment methods supports a blended, flexible approach to training. Trusts can still use face-to-face training, but with CDEP before or afterwards to enrich, affirm or refresh knowledge. CDEP certificates offer COPD endorsement to make training more appealing, as they can be utilised for professional revalidation and appraisal. The training can be revisited, supporting ongoing learning, as well as accessed via a computer, smartphone or tablet. As it is free for users, payment or trust funding is not a barrier to access, further supporting dissemination and accessibility
