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P04 Implementation of paediatric diabetes self-management in hospital
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  1. Nabil Boulos,
  2. Carolyne Salvin
  1. Southampton Children’s Hospital

Abstract

Introduction and Aim Insulin remains a common cause of clinical incidents leading to patient distress or harm in hospitals.1 Patients with diabetes or their adult carers often have greater knowledge of managing their diabetes than non-specialist hospital staff responsible for their care. This project aims to implement the practice of diabetes self-management for paediatric inpatients at a large teaching hospital. The key objectives are to improve insulin safety on the ward and empower families to safely take ownership of their inpatient diabetes management if they prefer.

Method The project comprised four key steps. First, a policy for paediatric diabetes self-management was developed in consultation with the diabetes multidisciplinary team, paediatric pharmacists, senior inpatient nurses, and emergency department staff. The policy details the risk assessments and selection of levels of self-management in line with national recommendations.2 3 Second, a new diabetes paper chart was created, offering a unified tool for detailing plans on insulin dosing, assessing the level of self-management, and documenting blood glucose levels and other observations relevant to diabetes care. Third, 7 children with diabetes and their parents were consulted on the design of the self-management documents. These included a parent information leaflet and sections of the paper chart used by children or parents who are self-managing, which allows a continuum of written communication between the family and the health professional in hospital. Fourth, extensive staff education and training was delivered, including presenting at the divisional grand round, ongoing ward-based education during and after implementation, online video teaching published on the staff intranet page, and a diabetes resource folder made available on each paediatric ward.

Results Over a development period of 12 months, the policy and associated chart were approved by trust governance and drugs committees, with feedback from children with diabetes and their carers incorporated into the final versions. In May 2023, the process was implemented across all 12 paediatric inpatient areas, including the children’s emergency department, high dependency ward, and inpatient behaviour support unit. Ward staff from all areas demonstrated good knowledge of the new practice. In the first month following implementation, four children with diabetes were admitted to hospital, and all were safely managed on the new self-management pathway.

Conclusion To our knowledge, this is the first initiative in the UK to successfully integrate the full scope of diabetes self-management, insulin self-administration, and documentation of diabetes care in a paediatric hospital setting. The pathway has been rolled out successfully and safely across the children’s hospital, with positive reception from all staff involved. Future plans include an audit and a patient satisfaction survey over the first 12 months after roll-out to capture the views of families during their hospital stay under the new pathway.

Reference

  1. Cousins D, Rosario C, Scarpello J. Insulin, hospitals and harm: a review of patient safety incidents reported to the National Patient Safety Agency. Clin Med 2011;11:28–30.

  2. Association of Children’s Diabetes Clinicians (ACDC). A practical approach to the self management of diabetes as an inpatient for children and young people under 18 years, 2023. http://www.a-c-d-c.org/endorsed-guidelines/

  3. Joint British Diabetes Societies for Inpatient Care (JBDS-IP). Self-management of diabetes in hospital, 2023. https://abcd.care/resource/jbds-04-self-management-diabetes-hospital

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