Endocrine Abstracts

Background: There exists low confidence in prescription of multiple daily injections (MDI) for newly diagnosed Type 1 Diabetes Mellitus paediatric patients among paediatric doctors at Basildon & Thurrock University Hospital (BTUH).

Aim: To improve the confidence in MDI discharge prescriptions for paediatric doctors of all grades via adaptation of local guidelines.

Methods: We designed an adaptation of existing local guidelines as posters to enhance familiarity of MDI prescription guidance and avoid prescription errors. The intervention was delivered in a single paediatric unit to doctors of all grades. Feedback was collected and the confidence of doctors in their MDI prescriptions was evaluated pre- and post-intervention. Questionnaires were distributed to all paediatric doctors within the unit assessing their confidence in MDI prescriptions with a numerical scale of 1–5, and whether they routinely referred to existing local guidelines. Existing guidelines were adapted in consultation with the local paediatric diabetic MDT, and East of England paediatric diabetes network to display MDI guidance in a more concise format, with example MDI discharge criteria. These guidelines were distributed to the paediatric MDT via email, and displayed in visible areas of the department.

Results: Of the 13 doctors surveyed, 10 provided pre- and post-intervention feedback (77%), with statistical significance calculated via unpaired t-tests. 90% of paediatric doctors routinely refer to local guidelines for guidance on MDI prescriptions. However, 50% felt that existing local guidelines were not easily accessible, taking into consideration time and ease when locating them. The pre-intervention mean confidence score for completing MDI prescriptions was 1.9 (S.D. 0.83), increasing to 4 (S.D. 0.63) post-intervention (95% CI 2.79–1.41, P<0.0001). 90% of paediatric doctors felt that the design and display of the MDI guidelines optimised patient care.

Conclusions: Following presentation in the local audit and QI meeting, the adapted guidelines were included in the junior doctor induction programme and made available on the local intranet. Adaptation of local guidelines to include MDI prescription guidance has shown an improvement in confidence of MDI prescriptions for paediatric doctors, with the vast majority finding the intervention significant for the optimisation of patient outcomes.