Implementing ThinkGlucose in Cambridge

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The challenge 

Cambridge University Hospitals (CUH) decided to implement ThinkGlucose in November 2009, having identified that 16% of their inpatients had diabetes. After establishing their ThinkGlucose team, further audits revealed regular insulin errors, lack of appropriate footcare, poor knowledge of hypogylcaemia among ward staff and negative patient feedback/experiences. The ThinkGlucose team wanted to work to improve staff’s knowledge and confidence in caring for patients with diabetes. The aim The team identified six key areas for improvement: footcare, safe use of insulin, hypoglycaemia awareness, appropriate and timely referrals to the diabetes team, self administration of insulin and staff education. What did they do? The ThinkGlucose team identified activities for each of the six areas:

• Footcare: The team developed a Think Feet! foot assessment tool to encourage nursing staff to assess all patients with diabetes and to offer appropriate foot pressure devices
  
• Safe use of insulin: Staff were provided with training on the safe use of insulin and laminated warning triangles were developed for drug trolleys
  
• Hypoglycaemia awareness: Staff education was facilitated by a new hypo reference guide and flowchart which are available on the intranet and as inserts for bed end notes
  
• Appropriate referrals: The team developed referral criteria for staff ID cards and lanyards
  
• Self administration of insulin: A new self administration of medications (SAM) flowchart was developed for insulin so patients could be assess for suitability to administer their own medication while on the wards
• Education: The ThinkGlucose team worked with the rest of the diabetes multidisciplinary team to create a diabetes education package that has been rolled out across the trust. ThinkGlucose now features on nine of the trust’s rolling education programmes including foundation year 1 and 2 doctor training, qualified nurse practitioner induction training and health care assistant training. Two wards are approached every two months for ThinkGlucose training, and a ThinkGlucose intranet site has been set up for staff. 

What happened?

Findings from the latest National Diabetes Inpatient Audit showed that CUH reported insulin errors of 14% compared to 26% across all trusts who took part in the audit, and diabetes management errors of 8.7% compared to 20% nationally. Additionally, appropriate foot pressure devices are now available for wards to order directly when they need them.  

Key outcomes

• Insulin errors at 14% compared to 20% nationally
  
• Diabetes management errors were 8.7% compared to 20% nationally
  
• Wards have direct easy access to foot pressure devices
  
• ThinkGlucose intranet site available for all staff to access