Background: The Diabetes Centre at St Vincent’s Hospital Sydney (SVHS) has delivered a Diabetes Nurse Educator (DNE)-led Insulin Stabilisation Program since 1979 with the primary goal of improving patients’ blood glucose control without hospital admission. The Insulin Stabilisation protocol was last reviewed in 2006. Clinical care advances and program inefficiencies led to a redesign project.
Aim: To redesign the Insulin Stabilisation Program and establish evaluation measures to assess program efficacy.
Method: In 2016 a literature search and review of other tertiary Diabetes Centres programs identified insulin stabilisation studies, position statements, clinical guidelines and service procedures. Clinical practice improvement methodology was utilised to conduct brainstorming and multi-voting exercises with the SVHS diabetes team. Process flow-diagrams, cause and effect diagrams and Pareto chart analysis were used to prioritise redesign goals. Plan, Do Study, Act cycles were undertaken in identified priority areas. A Working Party was established and met fortnightly.
Results: The program was renamed the Insulin Dose Adjustment (IDA) Clinic. A dedicated database, mobile phone and daily DNE roster was established. Patient demographics, diabetes type, date of enrollment and discharge, clinic completion/non-completion, reason for non-completion and HbA1c pre and post enrollment were recorded. A clinic procedure and accompanying forms were drafted, trialed and revised. In contrast to prior practice, the DNE was primarily responsibility for making and maintaining contact with patients. Insulin titration prescription and target blood glucose levels were added to clinic referral forms. An initial insulin assessment checklist, patient information sheet, documentation chart, patient experience questionnaire and IDA Clinic procedure audit tool were developed.
Conclusion: The redesign of the IDA clinic and associated procedure has standardised care delivery. Evaluation measures have been established and will be used to assess efficacy of the clinic in the future.