Leeds Teaching Hospitals NHS Trust
Refers to specific NICE guidance of TA 57 (now TA 151)
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Aims and objectives
To incorporate insulin pump therapy as an option for routine care of children with diabetes. To create a structured education process for children and families to ensure consistency amongst staff, in preparation for teaching of pump therapy. 1. Develop a written curriculum for preparation and teaching of the insulin pump training process for families 2. Update resources to support teaching and learning 3. Improvement in clinical outcomes and/or quality of life for those using insulin pumps 4. To progress the availability and use of insulin pump therapy for children in the UK
Reasons for implementing your project
1. All staff on Leeds Children's Diabetes Team trained simultaneously in insulin pump therapy, in 2002 2. Pump teaching needed to be consistent as many staff involved 3. NICE guidance TA 57 published in 2003, recommending use of insulin pumps (since revised in 2008 as TA 151) 4. Increasing numbers of children needing/wanting insulin pump therapy
How did you implement the project
1. Creation of manual containing structured education programme for staff and patients (summarised in flow chart) 2. Creation of pump specific resources for patients, ward staff, school and early years staff. Schools information is available via Diabetes UK website as an example of shared good practice http://www.diabetes.org.uk/Professionals/Shared_Practice/Care_Topics/Diabetes-Care-in-Schools/Supporting-schools-with-supervising-or-administering-insulin-via-injections-or-insulin-pump-therapy-Dec-08-/ 3. LTHT children's diabetes team have commenced more than 100 children on insulin pumps since 2002 4. Paper written (in conjunction with Medtronic UK Ltd) and submitted describing our experiences in detail (published in Practical Diabetes International, Feb 2009, and Journal of Diabetes Nursing, date tbc) 5. Pump audit undertaken to determine clinical outcomes 6. Establishment of Insulin Pump Therapy module (MSc and Level 3) at Leeds University for professional staff
Pump Audit undertaken in conjunction with the Yorkshire Type 1 Diabetes Register (University of Leeds). 83 individuals, 0-18y 5% of total caseload on pumps in 2002/3 24% of total caseload on pumps in 2007 Mean HbA1c improved by 0.5% and was maintained in short/medium term Lower hospital admission rates for hypoglycaemia, hyperglycaemia admissions remained unchanged International Society of Pediatric and Adolescent Diabetes (ISPAD) Poster, Durban, South Africa, 2008 Paediatric Diabetes (2008) Vol 9 Issue s10
Key learning points
1. A Team approach (paediatrician, children's diabetes nurse specialist and paediatric dietitian) is essential 2. Don't start a pump service with the most challenging patients where pump therapy is seen as a 'last resort'. Select more 'straight forward' patients who are willing to work with the Team as you learn 3. Ward staff must be trained in insulin pump therapy and flexible insulin regimes. Younger children may have inpatient pump starts, so ward staff need to be confident in their management 4. Need co-operation of Local Education Authority to create tripartite agreements between health, education and families, to facilitate pump use at school and assistance for younger children. Schools information is available via Diabetes UK website as example of shared good practice 5. Ask parents/families for independent feedback about the usefulness of technology advances and pump features
Children's Diabetes Nurse Specialist
Leeds Teaching Hospitals NHS Trust
Is the example industry-sponsored in any way?