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Inpatient self-management of insulin

Inpatient self-management of insulin

This is an update on a story about managing inpatient diabetes that we featured in our Quality Account 2013/2014 [view more about diabetes inpatient management].


GOAL:
To support patients to self-manage their diabetes in hospital if they are well enough and willing to do so.

Why?

  • 10-20% of all inpatients at North Shore and Waitakere Hospitals will have diabetes
  • People with diabetes tend to have a longer length of stay in hospital (average 2-3 days more) than people without diabetes
  • People with diabetes are more likely to take longer to recover compared to other patients because they may:
    • develop chest and wound infections
    • experience complications with the prescribing and administration of medication if they have poor blood glucose management

What did we find?

  • Traditionally when patients come into hospital, they are expected to hand over the management of their diabetes to staff, even though many know their own condition better
  • In both Canada and the U.S.A., self-management of insulin is recognised as appropriate for patients who have come to hospital for something other than their diabetes and whose insulin dosage is stable [1,2]
  • A self-management approach was developed by the British National Health Service (NHS) [3] as a way of improving the care provided to patients with diabetes and aiming to:
    • improve patient safety and reduce insulin errors
    • optimise the timing of blood sugar testing and insulin administration
    • reduce the length of stay and re-admission rates
    • increase patient independence and decision-making and enhance the patient’s experience

What did we do?

Building on the British model, we trialled diabetes self-management on our medical and orthopaedic wards. The trial showed that many patients with diabetes come into hospital for other reasons and are well enough to continue with their normal routines.

Insulin self-management information for patientsAs a result of the trial we have:

  1. Designed a decision-making guide for staff to identify whether self-management is appropriate
  2. Developed information for patients and their families to encourage self-management
  3. Identified the best way to discuss and document the decision to self-manage
  4. Ensured that testing kits and medication was accessible to patients but safely stored

Insulin Self-Management Decision Making Guide for Staff
Insulin Self-Management Decision Making Guide for Staff


Did we make a difference?

  • Patients and their families have indicated that they like being able to continue with their normal routines while in hospital
  • After testing the self-management approach on four wards, the Diabetes Service will roll this out more widely in 2016

Where to from here?

  • In 2016, a diabetes-specific electronic patient survey will be rolled out on all wards, allowing for patients with diabetes to give specific feedback about the care they receive while in hospital
  • Following the introduction of electronic prescribing we will be able to collect data to measure the success of the self-management approach
  1. Clinical Practice Guidelines: In-hospital Management of Diabetes”, Canadian Diabetes Association.
  2. Diabetes Care in the Hospital, Nursing Home, and Skilled Nursing Facility”, American Diabetes Association
  3. "Guidelines for self management of diabetes in hospital", The Health Foundation [UK]

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