A team of diabetes nurses has reached the final of the prestigious Nurse Awards for developing a children’s health care plan that has been rolled out throughout the country.

Nursing Standard Nurse Awards nominee, Sandra Singleton

Sandra Singleton: shared working between health and education is vital Picture credit John Houlihan

The sub-group from the Children and Young People’s North West Diabetes Network has been shortlisted for the Sanofi Excellence in Diabetes Specialist Nursing Award and will find out if it has won at a ceremony in the Savoy Hotel, London, on May 1.

The Individualised Health Care Plan for a Child or Young Person who has Diabetes (ICHP) was developed by the team to improve care in education settings.

Children spend 25% of their waking lives in school and those with diabetes have wide ranging needs. School staff have to keep up with increasingly complex care regimes, including monitoring glucose levels, giving injections and managing changing insulin regimes, carbohydrate counting, treating emergencies and monitoring physical activities and sport.

‘This puts huge pressure on teaching staff in schools,’ says team leader Sandra Singleton. ‘We knew that shared working between health care and education was essential to ensure the best outcomes for children and young people with diabetes. Diabetes can affect a child’s concentration and perceptive skills and has a social impact as they develop and grow.’

However, there was little to support school staff – everyone was using different tools and they were not easy to read in an emergency situation.

‘There was no standard care plan in existence specific to caring for the child or young person with diabetes in the education setting,’ says Sandra. ‘The plan was to develop one to enable consistent care for children with diabetes and fit in with new legislation and before the implementation of new statutory guidance on supporting pupils with medical conditions.’

The nurse specialist was asked by the Children and Young People’s North West Diabetes Network to lead a sub-group including other paediatric nurses, school nurses, the network co-ordinator and parents to develop an online, step by step guide that was easily sent to school staff and nurses.

The resulting care plan is tailored to each child’s individual needs and supports and manages care for any age and insulin regime in nursery, schools or colleges. It covers all elements of day-to-day care and also what to do in emergency situations.

‘The aims was to meet all national guidelines and provide a clear and concise, evidence based but individualised care plan that can follow the child/young person through their educational journey,’ says Sandra, who works for Blackpool Teaching Hospitals NHS Foundation Trust.

The paediatric diabetes nurse completes the care plan, which can be used for all types of diabetes quickly and easily with the child/young person and their carer before sending it to school nurses or anyone else involved in caring for the child. It can be updated as needed, but is done at least once a year.

‘They are very easy to use and record all contact details,’ adds Sandra. ‘They also include a training log. Teaching staff and parents like the plan’s flow charts that can be individualised including what that child’s particular hypo treatment is, or if they are on insulin regime or insulin pump therapy.’

The IHCP can be printed out in an A5 booklet, so staff can have it for easy reference and in times of emergency can quickly refer to its coloured flow charts for guidance. The children are involved in setting goals for themselves and have a copy of the care plan for themselves.

‘It ensures a better care experience for the child,’ says Sandra, and the knowledge and confidence of the teaching and non-teaching staff in the education settings have also been enhanced.’

The care plan was initially trialled in three trusts and audited. It was presented to the national network in December 2013 for peer review by lead clinicians before it was amended to meet both national and international guidelines. The tool was then rolled out regionally and nationally through the diabetes networks.

‘Throughout the journey there has been continual assessment and evaluation by the sub-group and from professional clinicians in the teams that have been using it,’ says Sandra. ‘It has been evaluated at regional and national level.’ The team also got feedback from the Families with Diabetes National Network.

‘It took about a year to complete and we found the East England Network was developing a ‘Guidelines booklet ‘, we worked closely with them in the early stages and the care plan is included in their booklet.

In May 2014, the Juvenile Diabetes Research Foundation uploaded the IHCP that was incorporated in the East of England Document on its website.

Diabetes UK requested that the team adapt the IHCP to be a stand-alone document. This is now is available through their online resource. The charity’s clinical advisor Libby Dowling says: ‘Every child with diabetes should have an individual healthcare plan but we know some schools still have concerns around how best to compile one, and this is why this sample IHP, created by Sandra and her team, is such a valuable resource.’

‘We did not expect it to go as big as it did,’ admits Sandra. ‘The aim was to produce a standardised document initially for use within the North West network,’ says Sandra. ‘We never envisaged that we would end up with a national document that was supported by the two main voluntary organisations in the field of children's diabetes.

Director of nursing and quality Marie Thompson says Blackpool Teaching Hospitals NHS Foundation Trust is also proud of its inspiring nurse and her potentially life-saving work.

‘Sandra is an innovative nurse whose dedication has been recognised in her work with and for children with diabetes,’ she adds. ‘The care plan means every child in the country has access to a standard, individualised care plan, which gives the right advice in the case of an emergency and is a step-by-step guide to the daily management of that child’s condition.’

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