GIRFT’s quality improvement initiative aiming to improve insulin management in the community for patients living with diabetes – at the same time as offering a more efficient service for the NHS – is now being rolled out nationally.
Following an initial pilot of the GIRFT Community and District Nurse Insulin Programme (CADNIP), 20 Integrated Care Boards (ICBs) are now on board to take part in the scale-up of the initiative. An inaugural meeting was held in early December to present the background to the study and get feedback on the plans for data collection, implementation and evaluation.
CADNIP empowers community and district nurses to optimise glycaemic control through collaboration with community diabetes specialist nurses (cDSNs), helping to improve patient safety and reduce 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.
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 input from the cDSN for eight hours a week was around £9,000.
Professor Gerry Rayman, GIRFT’s joint clinical lead for diabetes, said:
“We are delighted to see this important initiative rolled out nationally, and judging by the enthusiasm and input from attendees at the inaugural meeting, there is a lot of positive thinking and energy to really make a difference to community nursing support for insulin administration. Although the first meeting has been held it is not too late for other ICBs to get involved.”
ICB and provider representatives interested in CADNIP can contact paula.johnston6@nhs.net
