Diabetes inpatient model of care; A rural experience

Diabetes inpatient model of care; A rural experience

Diabetes inpatient model of care; A rural experience (#24)

Jane Giles ¹ , Barbie Sawyer ² , Sharyn Phillis ¹ , Collette Hooper ¹ , Lucie Walters ³

Country Health SA, Diabetes Service, Adelaide, South Australia, Australia
Country Health SA, South East Regional Community Health Service, Mt Gambier, South Australia, Australia
Flinders University SA, Mt Gambier, SA, Australia

Background: The Australian Diabetes Society¹ provides guidelines for effective inpatient diabetes management which recommends that routine blood glucose control in hospital should occur early and continue throughout the admission. Recommended routine processes and protocols for hospital care can be challenging to implement for rural and remote hospitals in Australia due to high mobility of staff and limited access to specialist health professionals.

Aim: To implement an all of hospital diabetes model of care with standardised diabetes guidelines and protocols:

~ improve clinical outcomes

~ reduce hospital admissions and minimise patient length of stay

~ increase post-discharge follow-up for high risk patients

~ increase ward based clinical support

~ implement standardised guidelines and protocol

~ build capacity of hospital staff.

Method: An integrated model led by a Diabetes Nurse Practitioner (D-NP) in partnership with senior nurses and doctors was implimented. Guidelines and protocols were agreed to and implemented following mandatory training. Three case note audits (pre, 3 and 9 months post) assessed compliance with newly implemented protocols. Survey evaluations were undertaken at staff training sessions. A series of staff interviews were also undertaken at 9 months to investigate the impact of a D-NP in the hospital.

Results: A total of 209 case notes were audited over the 9 month period.

~ compliance with QID BG monitoring increased from 60% to 90%

~ BG measurement within first hour of admission increased from 22% to 60%

~ recording of HbA1c at admission increased from 5% to 20%

~ hypoglycaemia management by protocol was 100% when BG was recorded as per protocol.

~ D-NP engaged with 115 high risk inpatients with 22 high risk patients being followed up via the diabetes rapid access service

~ an estimated 39 bed days saved and 6 hospital admissions avoided.

Conclusion: Implementing an all of hospital approach to a diabetes inpatient model of care has positive clinical and service outcomes. D-NP availability for high risk inpatient clinical consultation, inpatient and staff education resulted in bed days saved and admissions avoided.