Endocrine Abstracts

Background: Our Diabetes Team look after approximately 220 T1DM patients aged 0–17 years. In 2014/15 NPDA we ranked amongst the top 5 paediatric units with mean HBA1c <65 mmol/mol. Susequently our ranking slipped, with increased mean HBA1c and fewer patients achieving HBA1c <58 mmol/mol.

Objectives: We recognised a particular problem with poor control in the first year after diagnosis and identified the need to drive change to be able to achieve improvement in outcomes for our patients. We also identified the need to provide our patients with bespoke education that will empower them to manage their Diabetes effectively.

Aim: HBA1c <48 mmol/mol at 3 & 12 months post diagnosis.

Methods: We joined the RCPCH National QI Initiative and over the past 7 months have planned and undertaken a number of small projects designed to help achieve our aim. First was the introduction of carbohydrate counting from diagnosis which required a huge amount of work to upskill ward staff and design new charts for use in educating staff and patients. Subsequent projects included early introduction of Expert Meters and downloading these at home via Diasend which allows team members to offer advice on blood glucose readings remotely and empower self-management. We are also developing a package of bite-sized teaching to deliver in clinic. PDSA cycles and Driver Fish Bone diagrams were used to design projects and metrics including time to first carbohydrate counting, HBA1c and average blood glucose are plotted on run charts. A knowledge survey prior to bite-sized teaching was performed and will be repeated once bite-sized teaching is embedded.

Results: Median HBA1c 44.5 mmol/mol at 3 months v’ 53 mmol/mol pre-QI. Mean Blood Glucose at 30 days post discharge 6.7 mmol/l. Further data will be presented.

Conclusion: Participation in the National QI Initiative has been enormously valuable in terms of improved ways of working and innovative ideas to improve the care we deliver. We have learned to be brave, fail fast and change the way we do things based on ‘Bright Spots’ and ‘Dark Spots’ as well as the evidence accumulating on run charts.