Endocrine Abstracts

Introduction: Frimley Park Hospital, Surrey had been a negative HbA1c outlier for 3 consecutive years. The Children’s and Young People’s (CYP) diabetes team embarked upon the RCPCH National CYP Diabetes Quality Improvement (QI) Programme in November 2019. There was little qualitative data on ward nurse education, however, experience revealed engagement in staff training was the main barrier. Although regular education sessions were available to ward staff, attendance was generally poor, and gaps were observed notably in staff knowledge and skills.

Aims: The team decided to optimise the safe discharge of newly diagnosed CYP with diabetes from the paediatric ward. We believe important key messages relayed from nursing staff during patients’ admissions form a key role in patients’ education, confidence, and experience.

Methodology: Fishbone analysis highlighted many essential factors to consider, such as staff knowledge, practical skills, set up of devices, resources, and patient pathways. We therefore prioritised ward staff education in terms of educational interventions. Data collection was through written or online quizzes. Confidence questionnaires both pre- and post implementation of the updated education, helped formulate scores.

Results: A total of 57 nurses were invited, 23 participated and revealed they were most confident with insulin injection administration, but least with blood glucose meter use. Nurses scored 20/25 pre-intervention and 23/25 post-educational intervention. A total of 30 doctors were invited and 27 participated at different intervals. Doctors revealed they were most confident in managing hypoglycaemia and least confident in carbohydrate counting on the ward. Doctors’ pre-intervention scores were 3.8/5 and 4.5/5 post-intervention. The data showed an improvement in both nursing staff and doctor’s knowledge and confidence in managing newly diagnosed CYP with Type 1 diabetes post-educational sessions. Other interventions included: updating ward guidelines, improved patient pathways, electronic discharges and prescriptions, introduction of Level 3 Carbohydrate Counting with dose adjustment prior to discharge, and provision of age banded insulin to carbohydrate ratio reference sheets to assist doctors with insulin dose calculation on diagnosis.

Conclusion: During the QI process we have learned that the task can be greater than anticipated, although with motivation, communication and teamwork, our goal was achieved.