Why do patients’ coming into hospital feel out of control of their diabetes management? It is a question I often ask myself whilst exploring how and can we fix this.
To provide a good inpatient service for people living with diabetes we must empathise with the challenges that people face whilst experiencing an acute admission to hospital. Diabetes patients’ are living longer due to pharmaceutical, educational and technological advances. They therefore find themselves admitted to hospital with a range of conditions not predominately related to their diabetes.
Patients’ report that despite their illness not be diabetes related, they experience issues with their diabetes management due to insulin or tablets being placed in fridges or locked in drug cupboards etc. for safety. This often results in patients’ having to ask for their medication. Delays to treatment often have a detrimental effect on patients’ independent management. This can result in confident patients’ becoming frustrated or unsure of their personal ability to manage their long term health condition, resulting in longer lengths of hospital stays.
Good diabetes care should be fluent from the first point of contact with Acute Services. Sadly the consensus across the country reports inpatients’ feeling frustrated with diabetes care. A lack of understanding and knowledge is palpable amongst colleagues of all grades throughout secondary care. Since COVID times my trust like so many others experienced a mass exodus of confident, experienced and competent staff. Therefore wards that had previously been well versed in diabetes management became diluted with a reduction in skill mix and knowledge.
As clinical lead of the nursing services my role is to support the diabetes specialist nursing team and colleagues throughout the trust. I am examining ways to promote effective, relevant education to staff thus supporting patients to experience a safe and non-disruptive hospital admission.
We must find a way to promote independent management of diabetes. We must ensure that patients who are able can continue to manage their diabetes medication independently. We need to change the mind-set of diabetes to factor in the relevance of staying independent, patients’ often know more about their medication and have been managing well at home. Well controlled diabetes patients’ can avoid hospital admissions throughout their lives and therefore only require minimal professional input. We need to respect their contributions and stop taking this responsibility away from patients when being admitted to hospital.
As a trust we are looking at developing a self-care contract to allow patients’ who are well enough to self-manage their diabetes, continue to do this. This contract will be completed with the clerking medic and patient on admission and evaluated on every shift to ensure that the patient is able and confident as an inpatient to continue their level of pre-diabetes control regardless of their location.
The goal is to promote a self-care model that can be mirrored across all long term health conditions in the future.
