Cornwall Paves the Way for Diabetes Care

There are 28,000 people in Cornwall alone with a high inpatient prevalence of diabetes.

Cornwall Paves the Way for Diabetes Care

A recent study showed that:

• In more than 100,000 in-patients with diabetes, those who experienced hypoglycaemic episodes were found to have had
longer hospital stays;
• 7% higher risk of inpatient mortality;
• 39% increase in hospital costs;
• 58% increased likelihood of discharge to a skilled nursing facility (Curkendell et al, 2009).

A team of diabetes nurses from Cornwall Partnership NHS Foundation Trust have developed point-of-care simulation training in response to ineffective traditional training methods following a serious untoward incident (SUI) involving hypoglycaemia mismanagement which proved to be fatal.

Made up of Clinical Nurse Diabetes Specialists Kim Sleeman, Amanda Davis and Amanda Veall, a project was put together to deliver a real-life simulation (SIM) module by the team to the ward where the SUI had occurred over a three month pilot period and to evaluate its effectiveness.

With diabetes care increasing in complexity, developments in practice required an increased depth of knowledge and skills from healthcare professionals. By using a human patient simulator that mimics a person experiencing hypoglycaemia, the ward team have to respond in real time with the resources available around them and in an environment that is safe not only for the clinician, but the patient also. It was hoped the SIM training would eliminate incidences of mismanagement of hypoglycaemia and reduce unnecessary hospital stays.

The team’s SIM training was and still is delivered to the entire multidisciplinary team, including nurses, healthcare assistants and junior and senior ward doctors Trust wide as part of a rolling SIM programme.

“The Trust has recognised the importance of cultural changes at the coalface by introducing integrated point-of-care SIM training” commented Amanda Veall, a Clinical Nurse Specialist in Diabetes.

“Challenging human factors in the work environment allows the team to learn together and improve performance, with consequent delivery of safer patient care, better outcomes and improved productivity” continued Kim Sleeman. “Rehearsing situations increases confidence and skills, so that when they are encountered in clinical practice, they can be managed calmly and efficiently. SIM not only develops skills and knowledge, but it also improves situational awareness required for good team working.”

As hypoglycaemia emergencies can occur at any time and place, and with bed-space being at a premium, SIM training has been given in bathrooms, corridors and day rooms, as well as in the wards.

Advantages of point-of-care simulation training:
• Key aspects of patient safety can be identified;
• Allows for actual teams to learn together in their usual working environment;
• Allows for testing of logistics and systems;
• Multidisciplinary team integration and training relevant to the workplace;
• Enables the discovery of latent safety issues;
• Identifies “system and process” errors in situ;
• Time effective (takes one hour for scenario and debrief);
• Increases staff engagement and motivation.

Following the training there was a 100% reduction in hypoglycaemia incidents seen on the pilot ward and a 64% reduction in hypoglycaemia incidences and 100% reduction of SUIs throughout the Trust; below average incidents of mild hypoglycaemia at 12.3% (national average 18.5%; National Diabetes Inpatient Audit [NaDIA], 2017) and patients reporting they were “satisfied” or “very satisfied” with the overall care of their diabetes while in hospital, which was above the national average by 6% (NaDIA, 2017).

Kim continued “Ipswich Hospital NHS Trust has already replicated our hypoglycaemia SIM training following a consultation with us. It really is an innovative training tool. It was received exceptionally well and demonstrated a positive impact of diabetes inpatient mortality and a decrease in the length of stay in hospital.”