Digital tool helps practice nurses improve diabetes care
The ‘information prescription’ tool, developed by Diabetes UK, alerts clinicians to key patient details during consultations, making it easier to provide tailor-made care.
The ‘information prescription’ tool, developed by Diabetes UK, alerts clinicians to key patient details during consultations, making it easier to provide tailor-made care
In the 14 years Nicola Milne has been a practice nurse she has seen the number of people with diabetes at her practice increase from 400 to 700, while the overall list size has remained the same.
She has also seen a change in the patient profile, with people being diagnosed with diabetes at a much younger age and presenting with more complex needs, meaning greater challenges for the clinicians who are caring for them.
That’s why she welcomes the information prescription, an evidence-based digital tool that helps patients work with their GP or practice nurse to improve their care and health.
The tool alerts clinicians to key information on their patient’s condition during consultations, such as whether their blood glucose readings, cholesterol or blood pressure need particular attention.
Importantly, the clinician can then print out tailored graphics and information to support patients to self-manage at home, all on one easy-to-review sheet of paper.
‘Diabetes is an interesting clinical area: there have been lots of advances, cases are getting more complex, and there are newer therapies that are helping to transform care and reduce complications,’ says Ms Milne, a practice nurse in south Manchester who is also a Diabetes UK clinical champion (see box).
‘It’s difficult for all clinicians to keep up with the changing landscape. For example, in an afternoon, a practice nurse will do a couple of asthma reviews, smears, maybe one diabetes review. So it is helpful to have an alert on the computer for what to look out for.’
The information prescription, which has been rolled out to general practice by Diabetes UK in partnership with healthcare software company EMIS Health, alerts clinicians to the patient’s HbA1C levels, blood pressure and cholesterol during the consultation, directs the clinician to the area that needs most attention, and provides the patient’s two most recent results for all three tests, allowing easy comparison. This can all be printed as a single sheet of information that the patient can take home.
As a practice nurse, Ms Milne finds the whole process helps her to engage patients in their own care, by providing easily understandable information that they can take away with them. The pictorial nature of the information, illustrating the potential impact on the patient’s body if their HbA1C isn’t properly controlled, for example, helps people to understand why it is important.
Consistency in care
‘We’re able to show people what’s happening with their blood cells,’ she says. ‘And because we’ve got the information there during the consultation, the person with diabetes and the clinician can look at it together, and we can work together to set appropriate targets. For example, if someone has high blood pressure, we might discuss reducing salt intake, becoming more active, diet or medication.’
Ms Milne, who formerly worked as a midwife, was involved in developing a specific version of the tool for women with diabetes who might become pregnant, or want to have children. ‘Younger people are developing diabetes, so we now have people with type 2 diabetes who are of childbearing age,’ she says. ‘If a woman is 39, for example, she might be planning a pregnancy, and the clinician needs to know this because we need to consider things like medicines and contraception, and folic acid.’
Clinicians welcome the prompts, she says, because it alerts them to important aspects of care that might be easy to overlook during the course of a consultation. A similar tool is being developed for chronic kidney disease, she says, and others are in the pipeline.
One of the major benefits is ensuring consistency in care, says Diabetes UK head of care and clinical nurse specialist in diabetes Dan Howard. ‘Reducing variation in diabetes care is essential,’ he says. ‘With the information prescriptions, we’ve listened to people with diabetes and healthcare professionals to design a simple and effective tool that is now accessible to 98% of GP practices in the UK.’
Become a Diabetes UK clinical champion
Are you a diabetes specialist nurse (DSN) who would like to make a difference as one of Diabetes UK’s clinical champions? Applications for the next cohort of champions are now open and DSNs in particular are being encouraged to apply.
Diabetes UK clinical champions are healthcare professionals from across the diabetes pathway, who are supported to develop their own leadership style and to learn new skills to help them deliver a project to improve care in their area.
Projects have included working with care home staff to provide training, establishing local diabetes networks, and improving training for schools in supporting children with diabetes.
Applicants should be in a sufficiently senior position to implement meaningful change in their local area, but will be supported by Diabetes UK during the two-year voluntary programme.
Applications close on 27 March. More details can be found here.
Jennifer Trueland is a freelance health writer