Betsi Cadwaladr University Health Board Local Delivery Plan for Diabetes Response to Together for Health A Diabetes Delivery Plan

Transcription

1 Betsi Cadwaladr University Health Board Local Delivery Plan for Diabetes Response to Together for Health A Diabetes Delivery Plan 1. BACKGROUND AND CONTEXT Together for Health a Diabetes Delivery Plan was published in 2013 and provides a framework for action by Local Health Boards working together with their partners. It sets out the Welsh Government s expectations of the NHS in Wales in delivering high quality care ensuring the right patient has the right care at the right time. It therefore focuses on maximising efficiency and effectiveness, tackling variation in access and reducing inequalities in service provision across themes. The National Delivery Plan sets out action to improve outcomes in the following key areas between now and 2016: Children and young people Preventing diabetes Detecting diabetes quickly Delivering fast, effective treatment and care Supporting living with diabetes Improving Information Targeting research 2. DEVELOPMENT OF BETSI CADWALADR UNIVERSITY HEALTH BOARD LOCAL DELIVERY PLAN FOR DIABETES In response to the Together for Health A Diabetes Delivery Plan (2013), Health Boards are required, together with their partners, to produce and publish a detailed local service delivery plan to identify, monitor and evaluate action needed within timescales. The BCUHB Executive Lead for Diabetes will need to report progress formally to the Board against milestones in the delivery plans and publish reports on the websites at least annually. In late 2013 the Health Board commissioned Deloitte to undertake a piece of work looking into unscheduled care. Their report was presented to the Board in December Deloitte undertook a Deep Dive approach into Diabetes which was delivered in two workshops in October 2013 which were attended by BCUHB clinical staff and representatives from the 3rd sector. 3.BCUHB ORGANISATIONAL PROFILE According to the Exeter database BCUHB serves a population of around 715,000. There are 14 localities and 115 GP practices. This figure could be an overestimate as it includes English residents registered with Welsh GPs, as well as Welsh residents registered with English GPs DDP BCU v8 Page 1

2 The Quality and Outcome Framework (QOF) in general practice suggests there are 705,531 registered individuals as at 31st March There are three district general hospitals. 3.1 Prevalence of Diabetes in North Wales A Diabetes Prevalence Model has been developed through a strategic programme of Yorkshire and Humber Public Health Observatory in collaboration with a Working Group of academics, clinicians and practitioners in the diabetes community. These give the best estimates of diabetes prevalence for the UK including Wales. The table below gives the estimated number of people aged 16 and over with diabetes for the six North Wales counties and an overall figure for North Wales for 2010 and a projection for Number Prevalence Lower uncertainty limit Upper uncertainty limit Wales 218, % 6.9% 11.9% North Wales 50, % Isle of Anglesey 00NA 5, % 7.2% 12.7% Gwynedd 00NC 8, % 6.7% 11.8% Conwy 00NE 9, % 7.9% 13.7% Denbighshire 00NG 7, % 7.2% 12.8% Flintshire 00NJ 10, % 6.4% 11.3% Wrexham 00NL 9, % 6.4% 11.4% DDP BCU v8 Page 2

3 2020 Number Prevalence Lower uncertainty limit Upper uncertainty limit Wales 264, % 7.8% 13.6% North Wales 60,820 Isle of Anglesey 00NA 6, % 8.4% 14.7% Gwynedd 00NC 9, % 7.5% 13.2% Conwy 00NE 11, % 9.0% 15.6% Denbighshire 00NG 9, % 8.4% 14.8% Flintshire 00NJ 12, % 7.6% 13.3% Wrexham 00NL 11, % 7.4% 13.1% Thus we can see that between 2010 and 2020 there is expected to be a 20% rise in the number of people in North Wales with diabetes (diagnosed and undiagnosed). We also collect data from general practice as part of the quality and outcomes framework. These give numbers for the identified cases of diabetes for each practice population in those aged 17 and over. Quality and Outcomes Framework (QOF) data is primarily collected to monitor GP practice performance against their contract. Analyses and interpretation of QOF data for other purposes should therefore be treated with caution. However, for the past 3 years, across North Wales practices the prevalence in this age group (17 and over) of identified cases of diabetes is 6.4% / 5.2% of the overall population (36,748 individuals). The densest populations of patients with diabetes are in North Denbighshire, Conwy East, North West Flintshire and Meirionnydd.. Hence we can conclude that diabetes is a major health issue for North Wales. We currently have over 50,000 people with diabetes in our population of 16yrs and above, and this is likely to rise to over 60,000 by It is also apparent that a significant number of people currently with diabetes have not been identified, and will therefore not be receiving advice or treatment. Additionally there will be a large number of people at high risk of developing diabetes, many of whom will be unaware of the risks they face. 3.2 Challenges The increasing prevalence of diabetes means that services will ultimately become unsustainable unless we can reduce the number of new cases developing. It is in principle an avoidable cause of much morbidity and mortality. The main risk factor is overweight/obesity, related to poor diet and lack of physical activity. The first and primary DDP BCU v8 Page 3

4 challenge then is to reduce the number of people developing diabetes through the full implementation of the obesity pathway as resources and capacity permit. In addition to enhancing individual motivation, attention must be paid to the obeso-genic environment and social determinants, especially through partnership working with local authorities and other agencies. Ultimately supportive government action at UK and Wales level is needed in the regulation of food outlets, and food production, so that processed foods, rich in sugars, fat and salt are not so readily available to the extent that choice becomes a meaningless term. More than 50% of the adult population in North Wales are overweight or obese. Between and the number of people who are overweight or obese in BCUHB increased. Within the area there is variation with Denbighshire, Flintshire and Wrexham showing an increase, whilst declines were seen in Anglesey and Gwynedd. Conwy remained the same. When obesity alone is studied similar trends are noted. Adults who were overweight or obese, Wales, Betsi Cadwaladr UHB & unitary authorities, age-standardised percentage, & %Overweight % Obese % Overweight % Obese Betsi Cadwaladr UHB Isle of Gwynedd Conwy Denbighshire Flintshire Wrexham Wales Source: Welsh Health Survey In addition only 32% of adults in BCUHB currently meet physical activity guidelines There is much overlap with the preventative aspects of the heart disease and stroke delivery plans, and a more joined up approach to the prevention of chronic disease (to include diabetes, heart disease, renal disease and stroke) would be the preferred direction of travel in line with current thinking. In addition to the prevention of obesity in the general population, we also need to target those at high risk of developing diabetes through the systematic use of a risk assessment tool and offering of appropriate interventions. This would best be done through primary care, and could be linked to the vascular risk assessment tool still under consideration DDP BCU v8 Page 4

5 Delivery in North Wales will need to move forward in line with an as yet still developing All Wales approach. In the meantime an identified local priority is to develop a pathway for identifying those who are at high risk of developing diabetes over the next few years. It will be a significant challenge for primary care to take on risk assessment and intervention in a systematic way, as there are severe recruitment difficulties to general practice in some areas of North Wales, and primary care is under resourced for taking on additional work. 3.3 Service Challenges There are marked differences in service provision across North Wales, and the challenge will be to implement a pathway of care across the area, community based, which gives equitable outcomes for all. A number of areas have been indentified for particular attention, namely: The provision of structured education to all those newly diagnosed with diabetes in line with all current guidance, to enable patients to take a full role in managing their own condition; The provision of adequate foot care across North Wales, again reducing unnecessary morbidity which can include amputation. In addition we want to ensure appropriate services for children and young people such that: children and young people lead healthier and more active lives as a result of improved glycaemic control; a reduction in the proportion of children and young people with diabetes at diagnosis; a reduction in the proportion of children and young people admitted for diabetes related complications (DKA and Hypoglycaemia) DDP BCU v8 Page 5

6 4. SUMMARY OF THE PLAN - THE PRIORITIES FOR All Wales Diabetes Implementation Group The All Wales Implementation Group (AWDIG), chaired by Adam Cairns, Chief Executive Officer of Cardiff & the Vale Health Board, has been established to consider all Health Boards Delivery Plans and Annual Reports and to note areas for sharing good practice. It will not be the role of the ADWIG to approve or performance manage delivery this will be the role of individual Health Boards. The AWDIG, at a recent all Wales meeting in October agreed on 4 key areas to be implemented in 2014/15 and requested support for these areas from all Health Boards. Priority areas for future years will be determined using the same process but each priority is aligned to the seven themes as set out in the National Diabetes Delivery Plan. The priority areas agreed are:- Children and Young People Preventing Diabetes Making our services as effective as possible Helping people to manage their care 4.2 BCUHB Priorities 2014/15 Following the meeting and direction of the All Wales Diabetes Implementation Group the following areas have been identified by BCUHB as priorities for 2014: 1. Diabetes in children 2. Preventing Diabetes 3. Self Management Education in Diabetes 4. The Diabetic Foot The tables in the action plan below have been set out in these 4 priority areas. This plan has been developed, taking into account recommendations from : Together for Health Diabetes Delivery Plan (Welsh Government 2013); Outcomes of the North Wales Clinical Symposia events held from March to May 2013; Deep Dive project for Diabetes led and facilitated by Deloitte and reported to the Board of BCUHB in late Additionally as part of the BCUHB Diabetes Planning & Delivery Group s actions for 2013 to establish Task and Finish groups to interrogate service redesign options in the following key DDP BCU v8 Page 6

7 areas; these groups will continue this development and incorporate the AWD IG priorities where required Delivery of Structured Diabetes Education for Adults with diabetes Development of a North Wales Diabetes pathway Co-operational working with Medicines Management in order to promote quality and efficiency in prescribing within diabetes Health Professional Education (Supporting Primary & Community Care) BCUHB understands that the AWDIG will influence ongoing priority areas for focus annually throughout the term of the Diabetes Delivery Plan. BCUHB s Diabetes Planning & Delivery Group need also to take account of the recommendations from the Deloitte report in shaping a diabetes service that is co-operational and co-produced, that is Locality based and has a drive for quality and improvement for diabetes inpatient safety and admission avoidance. 5.0 PERFORMANCE MEASURES/MANAGEMENT The Welsh Government s Diabetes Delivery Plan (2013) contained an outline description of the national metrics that LHBs and other organisations will publish: Outcome indicators which will demonstrate success in delivering positive changes in outcome for the population of Wales. NHS assurance measures which will quantify an organisation s progress with implementing key areas of the delivery plan. Progress with these outcome indicators will form the basis of each LHB s annual report on diabetes. They will be calculated on behalf of the NHS annually at both a national and LHB population level. LHBs will produce their first annual report in March Some of the proposed indicators and assurance measures need further development and may change. LHBs will also report progress against the local delivery plan milestones to their Boards at least annually and to the public via their websites. It is expected that Local Delivery Plan and their milestones are reviewed and are updated annually from March DDP BCU v8 Page 7

8 ACTION PLAN Priority 1 Diabetes in Children Young People Outcome Ensure children and young people with diabetes have the best possible start in life and are given the opportunity to fulfil their potential Vision Ensure children and young people with diabetes lead healthier and more active lives and have the best possible start in life. This includes: A reduction in the proportion of children and young people with diabetes at diagnosis A reduction in the proportion of children and young people admitted for diabetes related complications (DKA and Hypoglycaemia) Current State: Achieving the vision is compromised by under resourcing of specialist diabetic services that are in line with national standards No. Detailed Actions for Year 1 Risks to delivery Mitigation of Risks Timeline to Delivery 1.1 Ensure that all children and young people Rising numbers of patients Need to ensure Currently with newly diagnosed Diabetes are seen with diabetes. continued achieving this within 24 hours by a Specialist participation in standard. and with their ongoing care delivered by a CYP Services are participating service reviews, multidisciplinary team. in the BCU clinical serviced particularly review which may bring considering Current Status: significant changes to service interdependencies. All children and young people are seen by delivery, including points of a paediatrician at their first attendance in access. Need to ensure secondary care and at the point of GPs have the All diagnosis of diabetes. Wales guidance regarding patients suspected of having diabetes. Accountable Officer CYP CPG Acute Programme Teams via Acute Service Board. Diabetes Pathway Working Group reporting to Acute Service Board DDP BCU v8 Page 8

9 1.2 Ensure that children and young people with suspected Diabetes have immediate sameday referral to a specialist Diabetes team. Current status: All children and young people suspected of having diabetes are referred on the same day to a specialist paediatric diabetes multidisciplinary team. 1.3 Implement all key Diabetes care processes referred to in the National Diabetes Audit. Current Status: NPDA % of care processes completed. However, this data is subjective due to differences in how teams submit information. Data input is often done by a clinical member of the MDT which compounds workload issues. 1.4 Deliver Diabetes structured education to all children and young people with Diabetes. Current Status: This is very variable across BCU but all children and their families are given some educational opportunities. This includes some structured education particularly in the East. Rising numbers of patients with diabetes. CYP Services are participating in the BCU clinical services review which may bring significant changes to service delivery, including points of access. Specialist paediatric diabetes multi-disciplinary team is under resources, particularly in Specialist Nursing Psychology, dietetics and business admin support. Data collation could be improved with admin support and funding for TWINKLE Data base system to improve submission. Inequity between all 3 North Wales sites. Both manpower and educational resources will be needed to deliver this important aspect of diabetes care to every child/young person, particularly to implement an All Wales structured education Need to ensure continued participation in service reviews, particularly considering interdependencies. Case of need to be made to the CPG for improving resources, particularly for specialist nursing, Psychology, dietetics and business admin support and including TWINKLE database system. Case of need to be made to the CPG for improving resources as above, to enable structured education to take place. An All Wales Currently achieving this standard. By Summer 2014 March 2015 Unclear CYP CPG Acute Programme Teams via Acute Service Board. Diabetes Pathway Working Group reporting to Acute Service Board. Diabetes Pathway Working Group reporting to Acute Service Board DDP BCU v8 Page 9

10 1.5 Ensure provision of an insulin pump service in line with NICE guidance. Current Status: This service has developed but only with the involvement of the insulin pump companies. In addition to this although we have no official waiting list, pumps are only offered when it is known that nursing support will be available for school training. Delays in pump starts do occur because of this. 1.6 Individualised care plans to be developed taking into account the young person wishes and stage of development. Current Status: A 2 yr transition process had been developed and audited in the East. Care plans are being developed and there is some working together with adult colleagues but this is limited, particularly in the West. curriculum which is being developed. Limited resources mean that links with LA education staff and primary care staff need developing to facilitate diabetes education. Inequity between all 3 North Wales sites. Currently under resourced for manpower and equipment to achieve this to ensure all appropriate children have access to pump service in a timely way. Adjustment of clinic times and availability, including job planning. Inequity between all 3 North Wales sites. Currently under resourced for manpower to achieve this to ensure all appropriate children have access to suitable transition services. Adjustment of clinic times and availability, including job planning. structured education curriculum is being developed which will improve equity and access. Care of need to be made to the CPG for improving resources as above including job planning. Specific pump equipment budget required. To continue working with adult colleagues to deliver a robust transitional service and to ensure all young people have an individualised transitional care plan. Case of need to be made to the CPG for improving completion time for this. March 2015 March 2015 Summer 2014 Diabetes Pathway Working Group reporting to Acute Service Board. Diabetes Pathway Working Group reporting to Acute Service Board DDP BCU v8 Page 10

11 1.7 Transition To develop a consistent approach to Transition service between adult and paediatric diabetes services across BCUHB That current variable service delivery status continues unchanged / unaddressed resources as above including job planning. Implement a collaborative working group to scope and embed a consistent transitional process across BCUHB. Implementation plan to be submitted to the DPDG. Summer (DPDG)2014 Diabetes Pathway Working Group reporting to Acute Service Board. Adult Diabetologist Departmental Leads. 1.8 Through the Wales Diabetes Interest Group establish a Quality Assurance Programme for Diabetes Services. Need to commit to quality assurance programme that includes peer review, audit and guideline development. Need to participate in PREM and NPDA but resources needed s above to enable this. To continue to work with the Brecon Group and Health Board to ensure BCU is fully engaged in the improvements strived for on an All Wales basis. Ongoing commitment Brecon Group. to Diabetes Pathway Working Group reporting to Acute Service Board. 1.9 Mandatory participation in quality assurance programme. Suggestion to buy into English CQuins peer review tool Case of need to be Summer 2014 made to the CPG for improving resources as above. Costs for 3 units. AWDIG DDP BCU v8 Page 11

12 Priority 2 - Preventing Diabetes Expected Outcome People are aware how to live a healthy lifestyle, make healthy choices that minimise their risk of developing diabetes and understand the consequences of not doing so Indicators Reduction in the incidence of type 2 diabetes Reduction in the inequality gap for incidence of diabetes across all age groups No. Detailed Actions for Year 1 Risks to delivery Mitigation of Risks 2.1 Produce an evidence based integrated Plan not agreed & A Task & Finish pathway for diabetes in BCUHB which will unable to Group is already incorporate detecting At Risk of diabetes communicate to in operation and through to acute and chronic management relevant Professional has linked this Colleagues. development into pre existing multidisciplinary Utilise Pathways for Diabetes Task and & Finish project team patient Produce a pathway process plan engagement utilising recommendations from work within the Deloitte Deloitte s deep Consultation with stakeholder dive into groups (see action 2.2) diabetes Timeline to Delivery Project team plan and present Draft Pathway to DPDG 1 st April 2014 Consultation process completed by DPDG meeting July 2014 Accountable Officer Diabetes Specialty Lead BCUHB DDP BCU v8 Page 12

13 Pathway sign off deadline Oct 2014 DPDG meeting 2.2 Communicate pathway for diabetes via 2 stakeholder engagement events specifically for primary care localities, matrons and other community staff Engagement Meeting 1 Consultation of initial draft pathway Engagement Meeting 2 Final Draft Engagement Meeting 2 Pathway Implementation Unable to attract sufficient stakeholder engagement to be representative Utilise pre existing Locality relationships to drive attendance at engagement events 1 st Engagement meeting confirmed 9 th April Diabetes Specialty Lead BCUHB. 2.3 Set up project group to scope out and plan how to measure compliance with the pathway once it is rolled out. None June 2014 Head of IT Chief of Staff Agree systems for measuring compliance Varying IT systems across BCUHB may cause an issue Ensure there are representatives from the three hospital IT departments on the group September 2014 Set up systems for measuring compliance See above See above December 2014 Prepare first report for DPDG on Speed of pathway Include risk March DDP BCU v8 Page 13

14 compliance to date with the pathway implementation may mean report is incomplete register 2.4 Utilise the Third Sector to provide high quality reliable advice on how to reduce the risks of diabetes and what care to expect. BCUHB - Diabetes UK Road show events to support At Risk of Diabetes Detection Road show support limited generally to one area per Health Board per year which can limit public access Liaison with DPDG to ensure that subsequent events are distributed across the Health Board Localities DUK Cymru Road show events: Llandudno 24/07/14 and Bangor 25/07/14 Priority 3 - Self-Management Education in Diabetes Expected outcome People are placed at the heart of diabetes care with their individual needs identified and met and feel supported and informed, able to manage the effects of diabetes Indicators An increase in the proportion of individuals who understand the affect of a new diagnosis of diabetes and start effective selfmanagement of the disease A reduction in the number of emergency admissions to hospital; readmissions to hospital; and average length of stay Increase the proportion of people who have well managed diabetes as define by NICE/All Wales targets for glycaemic control, blood pressure and lipids Increase the proportion of people with type 1 and type 2 diabetes who achieve effective self-management of the disease Increase the number of patients having well controlled blood sugar levels Reduction in number of glycaemic emergencies as a result of diabetes DDP BCU v8 Page 14

15 Priority Detailed Actions for Year 1 Risks to delivery Mitigation of Risks 3.1 DPDG Task & Finish Group Self Explore Management to: alternative Develop a service proposal and implementation plan for self management for adults with Type 1 and Type 2 diabetes in BCUHB 3.2 Complete dietetic led Type 2 Diabetes at Diagnosis roll out across BCUHB and continue to monitor effectiveness 3.3 To measure referral rates, time to referral and time to be seen in the New Type 2 Group education 3.4 DPDG to Review current delivery of DAFNE programme and scope wider equitable roll out by 3 Diabetes Teams. Service proposal plan not approved Non-Funding of business plan Suitable venues and dietetic staffing to deliver and administer the process Loss of data collection Non approval of self management business plan limits scope for avenues funding DDP BCU v8 Page 15 for Revise Service proposal plan Venues have been secured and will continually be reviewed to ensure appropriateness for delivery. Staffing identified and prioritised and cover in place Data is being collected manually and electronically to reflect actions Scope capacity of current resource to Timeline to Delivery Service proposal plan completed. Report progress DPDG July 2014 / Oct Final time line to approval Dec July 2014 Being collected prospectively so reports can be generated as required with some lead in time Report progress DPDG July 2014 / Oct Accountable Officer DPDG T&F Group for Diabetes Self Management Assistant Director of Finance Head of Dietetics Head of Dietetics Chief of Staff for Primary, Community & Specialist Medicine Clinical

16 3.7 Develop Key Performance Measures to ensure we can measure effectiveness of services in relation to expected outcomes:- equitable service delivery options offer DAFNE limited Final time line to approval Dec Programme Group Associate Chief of Staff Nursing as above Head of IT Establish group of IT and clinical personnel to scope out the appropriate KPIs and data development agenda As 2.3 above As 2.3 above March 2014 Identify personnel to report on KPIs Produce baseline report on assurance measures for the DPDG Shortage of staff to undertake the reporting As above Ensure contingency is allowed for in initial plan As above May 2014 From September 2014 and 1/4ly thereafter Produce further reports on a quarterly basis As above As above 3.8 Participate in all aspects of the National Diabetes Audit (including the Pregnancy Care, Footcare and Patient Experience parts of the expanded audit programme) and take appropriate action to ensure continuous quality improvement. Declining numbers participating equates to limited overall picture for BCUHB diabetes services. No clarity in responsibility. No named lead/s, Therefore service priorities continue to be planned on Replicate prior success of communication via Locality Leads to influence NDA participation Report to DPDG 1 st April 2014 Diabetes Clinical Lead DDP BCU v8 Page 16

17 3.9 Monitor Response to Locality approaches to engage fully in National Diabetes Audit demand not effectiveness Poor Primary Care response in spite of Locality Lead support 3.10 Monitor % uptake of NDA Participation is routinely reported annually by NDA process 3.11 Undertake a Patient Group survey of the current mechanisms for engaging and involving patients in service developments and supporting people living with diabetes. DPDG Lead to support opt out approach for NDA participation at National level Recorded uptake will inform 2015 approach End 2014 (unless NDA reporting delay) Diabetes Clinical Lead Diabetes Clinical Lead Patient Group Chairs for East, West and Central with DUK Cymru. Scope out current systems in place for engaging with patients with diabetes and agree with the DPDG the best way to undertake the survey. Shortage of personnel to undertake the scoping exercise May Design survey in line with guidance on engaging with patients Roll out survey July From September DDP BCU v8 Page 17

18 Priority 4 The Diabetic Foot Expected outcome People receive fast effective treatment and care so that they have the best chance of living a long and healthy life, with patients taking taking responsibility for lifestyle choices that contribute positively to their treatment and care. Indicators Reduction in the number diabetes related eye, foot, kidney and vascular complications Priority Detailed Actions for Year 1 Risks to delivery Mitigation of Risks 4.1 The DPDG will establish a Task & Podiatry have n/a Finish Multi Disciplinary group to completed many benchmark current Foot Services factors to this and will across BCUHB. This exercise will report as necessary inform the direction of service design to for the plan meet the following actions: 4.2 To establish a pathway vision of implementing the national foot campaign in each of the three acute hospitals and identify obstacles to implementing this pathway 4.3 To develop and report annually on the following measurements: (a) number of patients with a new ulcer(s), and the type and BCUHB approach must be developed in the three key stages of treatment- Screening/ Intermediate care services and Acute foot ulcer All fully auditable from Podiatry systems- TM for West and East- Medical lead clinics Consistent defined process to be shared for all three stages in all 3 sites. IT server data back up protocol. Written DDP BCU v8 Page 18 Timeline to Delivery Benchmark Report to DPDG 1st April August 2014 Available through current systems now. Accountable Officer Head of Podiatry Head of Podiatry and Lead Consultants from all 3 sites Head of Podiatry

19 severity of ulcer (b) Time from referral to review by a member of the Foot MDT, (c) Amputation rate below knee and below ankle 4.4 To develop an auditable foot screening and referral process for all patients with diabetes admitted to hospital, including: (a) proportion of patients with diabetes screened for foot problems (b) time from admission to referral to the Inpatient Foot MDT (c) time from referral to review by member of Foot MDT central Diamond BCUHB approach needed for all acute and community sites in partnership- silos not to be created instruction on process / method of extraction and delivery of data when required. Replicable data sources and process to ensure consistency Head of Podiatry; Diabetes Clinical & Podiatry Leads for each site 4.6 To promote engagement with Diabetes Foot Screening training and monitor staff uptake of the Foot Risk Awareness and Management Education elearning training module Single approach needed across BCUHB supported by Podiatry services annual update planned September FRAME update audit may need to be done locally as per CPD audits. Ongoing. Clear process and consistently auditable results required. Trainers pack to allow succession if required. Head of Podiatry Priority 5 - Insulin Safety for Inpatients with Diabetes 5.1 Reducing Insulin related Incidents: Implementing Safe Practice for the management of Inpatients with diabetes on Insulin Therapy. Short term redeployment of Diabetes Specialist Nursing resource Short term refocus on insulin safety education by BCUHB Board presentation of Insulin Safety Standards 27 th ACoS Medicines Management (Nursing) ACoS Primary DDP BCU v8 Page 19

20 PCSM & Medicines Management CPG to co-produce key standards to improve insulin management safety. Reduce Insulin Errors within Clinical Practice Education Standards to Reduce Insulin Errors Supporting Standards for Reducing Insulin Errors Relevance to Legislation or Healthcare Standard: NPSA/2010/RRR013 Safer Administration of Insulin HCS 7 Safe and Clinically Effective Care HCS 15 Medicines Management HCS 22 managing Risk & Health & Safety HCS 23 Dealing with Concerns and Managing Incidents (used for wider diabetes education) to focus on Insulin safety in collaboration with Medicines management resource may leave gaps in other essential diabetes education provision the Diabetes Specialist Nursing team is an acceptable measure pending an implementation plan for Think Glucose Campaign in BCUHB to address insulin safety as part of the wider improvement plan for diabetes inpatient management. Feb Community & Specialist Medicine (Nursing) Clinical Director Pharmacy & Meds Management (East) Diabetes Specialty Lead BCUHB. 5.2 Scope the Implementation of the Think Glucose Campaign in BCUHB -Prepare Implementation Plan -Seek CPG approval of Plan -Submit CPG agreed Plan to BCUHB Produced plan fails to gain CPG approval Plan fails to gain BCUHB Board approval Appropriate co-production of plan with ACoS / Business DDP BCU v8 Page 20 Feb 2014 Scoping completed & Draft prepared. Date for CPG Director of Nursing ACoS PCSM CPG Diabetes Specialty Lead BCUHB

21 executive Board management and finance personnel Approval (post DPDG meeting 1 st April 2014) Date for BCUHB Board consideration to be finalised post CPG approval of plan, DDP BCU v8 Page 21