Summary
Sheffield Teaching Hospitals Foundation Trust wanted to improve the care of in-patients with diabetes. A diabetes multidisciplinary team (MDT) was formed in the Trust, which carried out an analysis of critical incident reports and patient stories of diabetes management errors.
The analysis identified three areas where things can go wrong (triggers) and errors are made (harm):
- Lack of/inappropriate blood glucose monitoring
- Poor identification and inappropriate treatment of hypoglycaemic episodes
- Errors in prescription and administration of diabetic medications The MDT decided to address these areas by developing three care bundles.
Results
Some 108 in-patients with diabetes were included in the study (52 in the pre-intervention period). There was a total of 794.9 diabetic bed days: (440.9 pre-intervention). There was a 31.8 per cent reduction in the total number of harm events.
There was a 28.2 per cent reduction in the number of hypoglycaemic episodes and a 53.3 per cent improvement in the number of hypoglycaemic episodes treated appropriately. A 70.7 per cent reduction in prescription errors and 76.9 per cent reduction in diabetes medication administration errors were also demonstrated.
Staff knowledge questionnaire scores improved by 54 per cent.
Most components of the patient satisfaction survey also demonstrated significant improvements. In particular, there were improvements in staff knowledge of diabetes management, treatment of hypo and hyperglycaemia, and coordination between meals and administration of diabetic medications.
Following this evaluation, results were presented to senior nursing stuff, the executive board and clinical directors, and a number of further wards signed up for the second phase of the project. Data generated from this study was used in a business case to secure a 12-month full-time support worker to help in the second phase of the project.
The MDT also observed an increase in the number of appropriate referrals to the inpatient diabetes team. Looking ahead there are plans to roll out the project to a third set of wards within the Trust.
Challenge
The primary aim of the project was to investigate if a comprehensive in-patient diabetes management programme improved patient safety. The secondary aim was to investigate if the programme improved staff knowledge and patient satisfaction.
Solution
The three care bundles set up by the MDT were:
- New diabetes prescription and monitoring charts
- ‘Hypoboxes’ (brightly coloured, prominently-placed boxes which contain guidance and equipment to treat hypoglycaemia)
- New glycaemic control guidelines and ward-based diabetes education adapted from the NHS Institute for Innovation and Improvement ‘Think Glucose’ campaign.
Each package gathers together the evidence-based care necessary for improving inpatient diabetes service delivery and outcomes, against which compliance can be measured.
The care bundles were rolled out to four pilot wards (two general medical and two surgical). Before introducing the care bundles the number of harm events were tracked on each ward over a six-month period, and staff knowledge and patient satisfaction surveys were carried out.
Phased introduction of care bundles was performed over two months. After a three-month bedding in period, the MDT carried out post-intervention data collection.
