GIRFT is piloting a new quality improvement initiative which has been shown to improve insulin management in the community for patients living with diabetes, at the same time as creating a more efficient service for the NHS.
Trusts are being sought to join the pilot GIRFT Community and District Nurse Insulin Programme (CADNIP), which empowers community and district nurses to optimise glycaemic control through collaboration with community diabetes specialist nurses (cDSNs) – in turn improving patient safety and reducing hospital admissions.
The prevalence of diabetes is rapidly increasing and now affects more than one in four people aged 65 and over. In addition, advances in the treatment of Type 1 and Type 2 diabetes have contributed to improved life expectancy, increasing the number of older individuals with conditions such as dementia or limited dexterity who need a community nurse visit to support with their insulin.
The CADNIP initiative was born at Ipswich Hospital, part of the East Suffolk and North Essex NHS Foundation Trust (ESNEFT), to help tackle this increased demand.
Its aim was to provide guidance on safe treatment, de-escalate or escalate a patient’s requirements as needed and to upskill community nurses in glycaemic management to potentially reduce the number of district nursing visits.
This involved establishing monthly virtual meetings for community nursing teams with a community diabetes specialist nurse, with an initial face-to-face launch to introduce the project and discuss implementation followed by virtual training and monthly case reviews.
Individual insulin management plans were developed collaboratively and glycaemic targets agreed based on the patient’s frailty, life expectancy, cognition and risk of hypoglycaemia.
Regular district nurse education forums were also held to consolidate clinic learning, and ad hoc virtual consultations depending on patients’ needs.
Results from the first 12 months in ESNEFT included:
- Significant improvements in HbA1c outcomes (the measurement of a patient’s average blood sugar levels); e.g reduction in those with high HbA1c and fewer with low HbA1c at risk of hypoglycaemia;
- 43% reduction in the number of presentations to acute services;
- 59% reduction in ED attendances by individuals in the programme;
- 28% reduction in the number of hospital admissions;
- inpatient bed days reduced from 1,229 to 580 (a reduction of 53%)
- weekly district nursing visits reduced from 201 per week to 138; and
- annual cost efficiencies of almost £2m, factoring in considerations such as district nursing visits saved, savings in insulin costs, reduced ambulance conveyancing and reduced ED attendances. The cost of the cDSN for eight hours a week was around £9,000.
Professor Gerry Rayman MBE, GIRFT’s joint clinical lead for diabetes, said:
“We were amazed by how effective this intervention has been in the Ipswich and East Suffolk neighbourhood, not only in improving patient outcomes and safety, but also in delivering cost-effective care. By optimising insulin therapy, the approach has safely reduced the need for district nursing visits, and, where appropriate, has empowered people with diabetes and their carers to manage insulin therapy independently.
GIRFT is now aiming to roll out this initiative and pilot whether this good practice can be scaled more widely. Trusts taking part will be supported to collect and submit their data, and with regular insights into the process, before GIRFT undertakes the final data analysis.”
If you are interested in joining the CADNIP contact paula.johnston6@nhs.net or sam.watson10@nhs.net
