Features

Meet the nurses transforming diabetes care in the community

Trust's new scoring tool radically transforms diabetes care for housebound patients
Diabetes nurses at Solent NHS Trust have developed a tool to support community nurses caring for housebound patients with diabetes

New scoring tool transforms diabetes care for housebound patients

  • A trust's proactive innovations are transforming diabetes care for housebound patients with long-term illnesses
  • Community nurses in Southampton have been upskilled to provide diabetes care to patients who would not otherwise access it
  • A new paper-based tool can help community nurses to identify overlooked issues such as hyperglycaemia

Diabetes nurses at Solent NHS Trust have developed an innovative tool to support community nurses caring for housebound patients requiring insulin administration.

The assessment tool known as CRASH (chronic kidney disease, risk of frailty, amputations, steroids, hypoglycaemia/hyperglycaemia) provides a scoring system for nurses to identify and escalate patient issues.

The paper-based tool allows

...

New scoring tool transforms diabetes care for housebound patients

  • A trust's proactive innovations are transforming diabetes care for housebound patients with long-term illnesses
  • Community nurses in Southampton have been upskilled to provide diabetes care to patients who would not otherwise access it
  • A new paper-based tool can help community nurses to identify overlooked issues such as hyperglycaemia
Diabetes nurses at Solent NHS Trust have developed a tool to support community nurses caring for housebound patients with diabetes
L-R: Suzi Graves, Helen Rigden, Hong zhen Wang and Emma Ives receive an award on World Patient Safety Day from the Wessex Academic Health Science Network team 

Diabetes nurses at Solent NHS Trust have developed an innovative tool to support community nurses caring for housebound patients requiring insulin administration.

The assessment tool known as CRASH (chronic kidney disease, risk of frailty, amputations, steroids, hypoglycaemia/hyperglycaemia) provides a scoring system for nurses to identify and escalate patient issues.

The paper-based tool allows nurses to prioritise diabetes patient care via acuity scoring. It uses ratings of red, amber and green to place patients on different pathways, according to their acuity.

Using the tool to address overlooked health issues in the community

On the first World Patient Safety Day in September 2019, the diabetes nurses were presented with an award for their patient safety tool from the Wessex Academic Health and Science Network.

Integrated community nursing lead Suzi Graves says the tool is helping to address the issue of hyperglycaemia being overlooked.

'As a service we can provide enhanced care to housebound patients,' explains Ms Graves. 'Previous to this tool being in place, a lot of our patients had high blood sugars for long periods of time and actions weren’t being taken. We found that community nurses would act on low blood sugars because of the risk of patients becoming unwell, but they didn’t act on high blood sugars. With this tool we can act on high blood sugars and manage each patient’s condition safely.'

Empowering community nurses to accurately assess housebound patients

The CRASH tool provides a two-part assessment that considers how the patient is on a day-to-day basis and whether they have any new presentations. For example, recent discharge from hospital, if the patient has an infection and is taking steroids, if the patient has low or high blood sugar levels or a reduced appetite.

‘The aim of the tool is to keep patients safe and to proactively help community nurses to know that they don’t have to be a diabetes expert, this tool will guide them through assessing their patients.’

'Before the introduction of the tool, these patients did not have any contact with the diabetes service because they were housebound. The connections between hypoglycaemia and longstanding illnesses such as chronic kidney disease were not being made,' says specialist diabetes nurse Emma Ives.

'The aim of the tool is to keep patients safe and to proactively help community nurses to know that they don’t have to be a diabetes expert, this tool will guide them through assessing their patients.'

If a patient’s score adds up to four or more, they are referred to Solent’s community diabetes nurses who will create a personalised care plan and set blood sugar and HbA1c targets for the patient. If they are unable to hit their blood glucose target range, this would prompt another review to revisit their care plan.

Case study: 'The tool highlighted him as a red patient'

'We have a patient who had a high HbA1c level and dementia,' says community diabetes nurse, Helen Rigden. 'When we became involved in his care, we were able to work with him alongside the specialist diabetes nurses. The CRASH tool highlighted him as a red patient because of various issues including hyperglycaemic events.

'Now, his HbA1c level is coming down, we’ve increased his insulin and we have changed the timings of district nurse visits. The patient is now on a weekly GLP1 injection to bring his blood glucose down. We reviewed his medication and, because he didn’t want carers, we found he wasn’t taking some of his metformin until later in the day. We changed his medication to a modified release version and he now takes that in the morning when the district nurses go in to see him.'

Nurses are upskilled for a new role between community and specialist diabetes nursing

The CRASH tool is being used in central Southampton by the trust’s two community diabetes nurses – a new role that was introduced in May 2019 to improve diabetes care for housebound patients. This role sits between community and specialist diabetes nursing.

The two community nurses have been upskilled to carry out their role including receiving training on insulin devices. Their role is to review the district nursing caseload for housebound insulin administered patients. The nurses benefit from having protected time to review patients and escalate concerns.

'We’ve been able to personalise patient care plans and create personalised blood glucose and HbA1c target ranges' says community diabetes nurse, Helen Rigden. 'The tool helps us to prioritise the patients we should see and identify who is okay at the moment. We work with patients and their families, district nurses, GPs and the specialist diabetes nurses.

'The CRASH tool highlights issues and it’s there in the background when we are assessing and reviewing patients. When the tool is introduced for district nurse use, the new presentation assessment will help them to refer patients to us so we can review them or refer them onto the specialist diabetes service.'

New roles and new tool take the pressure off community nurses

'We see a reduction in demand for the community nurses from the original caseload,' says Ms Ives. 'We have patients on less insulin, their blood sugar levels are better controlled and we have patients that no longer require community nurse visits twice a day. Before we had the tool and the community diabetes nurses, we received minimal amounts of referrals to our service from the community nurses. That has increased, and patients are coming through to our service more appropriately now.'

The tool is being trialled by a specialist diabetes nurse in Portsmouth. The nurse reviewed 30 patients using the CRASH tool and found the outcomes recommended tallied with how she would have acted. Other areas of the country have also shown an interest in using the tool.

'It was great to get noticed via our award on World Patient Safety Day for using our initiative to get this tool out there,' adds Ms Ives. 'There is nowhere else doing this, especially with the community diabetes nursing role that we have here.'

Case study: 'We’re educating patients and their families'

'We have been teaching patients and their families how to do blood sugar checks and how to administer insulin,' explains community diabetes nurse Hong zhen Wang. 'This has helped to get some patients off the district nursing caseload as they don’t need to be seen as often. We have reviewed patients that were on a very low dose of insulin and in some cases, we have been able to get them off insulin altogether.

'We have increased the dose of insulin for some patients and this has helped to reduce their blood glucose and HbA1c levels. Through our training on insulin devices, we now have a patient who receives one injection a day instead of two.'



Julie Penfold is a health writer

 

 

 

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to primary healthcare.com
  • Bi-monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs