Healthcare Commissioning Forum

How to reduce medicines wastage and improve the quality of care and reduce length of stay for inpatients diabetes patients?

ThinkGlucose is designed to improve the care of people with diabetes when they are admitted to hospital. Patients with a secondary diagnosis of diabetes who receive the right care for their diabetes are able to return home fitter, more safely and with a positive patient experience.

The National Diabetes Inpatient Audit (2012) showed that 66% (n=11,866 inpatients with diabetes) of patients included in the audit were admitted for medical reasons other than diabetes with only 9% of patients admitted specifically for the management of their diabetes.

The median length of stay for inpatients with diabetes at the time of the audit was 8 nights compared to 5 for all inpatients in England. The audit highlighted a trend that diabetes patients admitted to hospital have a longer median length of stay. (Health and Social Care Information Centre, 2012)

ThinkGlucose provides a structured development programme for developing and improving the care of people with diabetes who are admitted to hospital. It brings together hospital diabetes specialist teams with colleagues in patient safety, clinical governance, and commissioning, surgical and medical specialities across the hospital to deliver improved effective efficient and patient friendly care to people with diabetes.

The programme aims to:
•   Increase the awareness of diabetes in inpatients and educate staff
•   Introduce early specialist involvement with an early discharge/follow-up plan to reduce the average length of stay
•   Reduce prescription errors and improve patient care through publicising updated guidelines from local and national guideline producers, for example NICE.
The ThinkGlucose safe use of insulin tool provides education materials and guidance on managing self-administration, which reinforces the importance of self-administration if the patient has the appropriate skills and capabilities.
The programme provides a package of products within the toolkit, such as a patient assessment tool and self-administration decision tree. It also raises awareness of other NHS Institute tools from other work programmes, such as experience-based design and the sustainability model. This learning and support aims to improve awareness and remove the obstacles to the treatment of patients with diabetes as a secondary diagnosis. Obstacles could be in the form of low awareness, lack of confidence and knowledge about diabetes and how diabetes can complicate the primary reason for admission.
ThinkGlucose provides a comprehensive package of service improvement, leading to a clinical pathway that will help to ensure that all staff is better equipped to care for inpatients with diabetes. By improving staff knowledge, patient assessment, management of patient medication and meals, patients will have fewer complications, get better quicker and be discharged earlier.

The original scope for ThinkGlucose did not include:

•   Community settings
•   Mental health
•   Paediatrics

However, ThinkGlucose has some applicability within these settings.

Dudley group of Hospitals launched the ThinkGlucose project across the organisation in August 2010; information relating to their experience is documented throughout this case study.

For further information please visit: https://arms.evidence.nhs.uk/resources/qipp/1008647/attachment