Reviewers Handbook. for Assessment of Patient Education in Diabetes in Scotland (APEDS)

Reviewers Handbook for Assessment of Patient Education in Diabetes in Scotland (APEDS)

Contents Reviewers Handbook for Assessment of Patient Education in Diabetes in Scotland (APEDS) Introduction...1 Review Process...2 Terminology...3 General Aspects...3 Philosophy...4 Curriculum, Aims and Learning Outcomes...4 Trained Educator...6 Quality Assurance...6 Audit...6 patient aspects...6 professional aspects...7 organisational aspects...8 References...8 Appendix 1. SCI-Diabetes Descriptors of structured education...9 2. Review of Structured Patient Education... 14 3. Reporting template for acceptable Programme...21 4. Reporting template for minor adjustments to the Programme... 2 5. Action plan template... 2 Acknowledgements: This document was developed by a variety of people through consultations and workshops. Contributors were people with diabetes and professionals from all Health Boards, Educational Leads in Diabetes, the Steering Group for the National Education Co-Ordinator and members of the Scottish Diabetes Education Advisory Group. NHS Education for Scotland 2012. You can copy or reproduce the information in this document for use within NHSScotland and for non commercial educational purposes. Use of this document for commercial purposes is permitted only with the written permission of NES.

Reviewer s Handbook This handbook must be read and utilized in conjunction with the Assessment of Patient Education in Diabetes in Scotland (APEDS) and Tool for Assessment of Patient Education in Diabetes in Scotland (TAPEDS) and the descriptors for recording structured patient education on SCI-Diabetes (Appendix 1). The ethos for reviewing educational programmes is of support and valuing quality. It should be a constructive experience for both reviewers and reviewees. Introduction The main outcome of reviewing structured patient education is to record education received by each person with diabetes on SCI-Diabetes and so lay the foundation for quality assured, incremental education being received by each individual living with diabetes. A secondary outcome is to increase the quantity and quality of education offered to people living with diabetes throughout Scotland. Reviewers have been nominated by the Educational Leads in each Health Board representing people with diabetes and professionals from all disciplines involved in diabetes care. Reviewers are considered by their peers to meet the following criteria: actively involved in delivering patient education to people with diabetes or a person living with diabetes who is actively involved in self-management and relates well to others are trained educators or a person living with diabetes who demonstrates the ability to educate others - not necessarily in diabetes have capacity for undertaking reviews have a collegiate approach have a strategic approach to care command the respect and integrity of their colleagues are willing to commit as a reviewer for a minimum of 3 years are willing to undergo training to be a reviewer It is expected that the workload would be the equivalent of 2 days for each programme being reviewed. Reviews will be conducted electronically with some telephone or email communications. INTRODUCTION 1

Review Process for assessing structured patient education programmes 1. Health Boards will be invited to submit their Programme Documentation for assessment to the Scottish Diabetes Education Advisory Group. The TAPEDS will inform the material to be submitted. Electronic submissions are required. 2. Submitted Programme Documentation will be sent to reviewers who will live or work in a different Health Board than the Programme for review. 3. There will normally be three reviewers for each submitted programme and must include one person with diabetes and one professional. The third person may be another person living with diabetes or another professional, preferably from a different professional group than the first one. One person will be identified as the Lead Reviewer. 4. The Lead Reviewer is responsible for co-coordinating the responses of the other reviewers and communicating the outcome to the Scottish Diabetes Education Advisory Group. All reviewers are expected to fulfill this role on a rotational basis. 5. The reviewers will individually review the programme according to the TAPEDS template (Appendix 2). 6. The reviewers will communicate with each other with regard to their findings, identifying any areas that need further exploration or clarification. 7. The Lead Reviewer will communicate with the Educational Lead for the Programme for clarification of any identified area. This may be by telephone, Skype, or independent visit. All reviewers will be encouraged to participate in these communications but the Lead Reviewer is the only one required to participate. 8. After any further exploratory communications, the reviewers will agree on the outcome. 9. The above process should be completed within 6 weeks of any Programme being submitted for assessment. 10. The outcome may be: a) The programme is acceptable for recording on SCI-Diabetes (Appendix 3) b) The programme is acceptable for recording on SCI-Diabetes subject to minor adjustments that must be undertaken within 3 months (Appendix 4). At the end of 3 months, the Educational Lead will submit amendments to the original reviewers who will determine if the adjustments have been made. c) The programme is not yet acceptable for recording on SCI-Diabetes. A detailed action plan will be compiled (Appendix 5) and the submitting Educational Lead asked to address it. The Educational Lead will be given 6 months to re-submit the Programme, with amendments, to the original reviewers who will determine if the adjustments have been made. d) Records of Programmes acceptable for recording on SCI Diabetes will be retained by the Scottish Diabetes Group. 2 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Terminology It is important that the same language is used when referring to submitted Programmes. For this purpose, a list of the most common terminology used is presented. This is in sequential order. Programme This relates to an entire educational experience. Normally education will be delivered over several hours, days or weeks. Programme relates to all the sessions delivered. Some Programmes may be delivered over one session e.g. Diabetes Footsteps developed under the auspices of Fife Health Board. A one session programme is still required to meet all the criteria of a programme. National Course This relates to those courses that have been developed under the auspices of research, normally a randomized control trial. Examples are: DAFNE, DESMOND, X-PERT Diabetes. Session This relates to one individual educational experience. It may occur in a group setting or on a one-to-one setting. It may be conducted face-to-face, over the telephone or other media. Ongoing education This relates to level 2 education 1. As such, it normally relates to one individual educational session. However, any level 2 education submitted for review must meet the criteria of a programme. Indicative content This is a list of topics that will be addressed. The indicative content may refer to the whole programme or may refer to one teaching session. A national course is not required to be reviewed using the APEDS and TAPEDS so long as it is being reviewed by its authorizing body and it has not been modified in any way. General Aspects Reviewers are asked to read the following pages in tandem with Appendix 2 and the submitted Programme for review. Each reviewer should complete Appendix 2 independently from other reviewers and using the Programme information submitted. The boxes will expand to accept written text. There are a few key components to note. If this is a national course that has been modified, it is important that such modifications are noted, for example, the duration of the programme, its timing, the content or any different resources utilized. TERMINOLOGY 3

There are a variety of ways in which people s learning needs are identified. If a person has been just diagnosed with diabetes, there is clearly a self-management need. If however a person has ongoing problems with, for example, hypoglycaemia, their learning need may be identified by a clinical requirement. Very few Programmes formally assess people s learning needs and hence this may not be explicit in Programme documentation. Philosophy The philosophy of the Programme may be presented as a mission statement, a philosophy or as an overall ethos. The philosophy should be communicated to participants, professionals referring participants to the Programme and to those participating in delivering the Programme. Hence, there should be evidence of the philosophy on all communications with others. It is good practice to involve people with diabetes in the development of the philosophy however, if the Programme is well established, this level of detail may not be obvious. Curriculum, Aims and Learning Outcomes The educational theory should support active learning by the participants. It may employ adult learning theory or child specific learning theories. Any educational programme will have a Programme Aim that is normally one sentence indicating the overall purpose of the Programme. Thereafter, the Programme normally has about 4-6 learning outcomes. These learning outcomes are high level and will be achieved by attendance at the individual sessions within the Programme. The number of individual sessions will vary according to each Programme timetable. Each individual session will have an aim and normally about 3-4 learning outcomes. The individual sessions will also have indicative content which is the list of actual topics or aspects to be covered within each session. Lesson plans indicate the methodology used to exchange knowledge, skills and attitudes. It may be highly structured, for example see the Diabetes Education Network website (http://diabetes-education.net/index. php?link=curriculum) or it may be totally participant led, for example, Conversation Maps TM. If there is no structured lesson plan, indicative content ensures that the topics are addressed. All education should reflect the knowledge of current research and hence the Programme content should be evidence based. New research findings should be obvious in educational programmes although reviewers need to be cautious about the time when a Programme is submitted for review and the timing of new research being available. One example might be the withdrawal of an oral hypoglycaemic drug in one month and yet the Programme mentions the drug because the Programme was delivered six months previously. 4 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

The focus of the aims and learning outcomes is to identify learning around aspects of knowledge, skills and attitudes. Kirkpatrick 2 has developed a framework for evaluation that identifies four levels. Kirkpatrick s framework is a simple and pragmatic model that is widely used. The levels and means of assessment are identified in the table below. Table: Adapted from Kirkpatrick 2 to meet diabetes education Level Meaning Assessment 1 Initial reaction to the learning programme Normally assessed by reaction questionnaires; post-it notes; 2 The resulting increase in knowledge or capability before and/ or after education 3 This involves applying the new knowledge to the persons life style that may include behaviour change Normally use before and after knowledge questionnaires. May include self assessment of knowledge. May include observation of skill rehearsal e.g. blood glucose monitoring Immediate assessment is more difficult as there is a time element necessary for the person to make changes and for others to see the changes. Observation is a key assessment tool. Participants may be encouraged to maintain a diary, reflective log, or develop an action plan. 4 This involves the major impact of the learning on the person s life style that may impact on others beyond the individual him/herself. Immediate assessment is more difficult as again, there is a time element necessary for the person to make changes and for others to see the changes. The major impact may be assessed through observation, assessment of attitudes and behaviours that promote self care management. Assessment would normally look at both hard data e.g. HbA1c as well as soft data e.g. patient satisfaction. Most education programmes delivered will be assessing Levels 1 and 2 only. It is impractical for programmes to assess at Levels 3 and 4 unless there is some long term follow up built into the programme. SCI- Diabetes will eventually be able to give some Level 4 data but this will not be available for some time yet. Assessment of learning therefore relates to what has been taught. While knowledge can be tested using questionnaires for example, it will probably only test recent, rote learning and will not necessarily test recall of knowledge or the application of knowledge to an individual s lifestyle. Learning may be evident by, for example, the development of a positive attitude towards regularly attending clinics where previously the person did not attend. A skill may be assessed by observing the person undertaking the skill for themselves. Coupled with all this, there may be literacy, numeracy and language issues that prohibit the use of a written assessment. CURRICULUM, AIMS AND LEARNING OUTCOMES 5

Reviewers are required to accept the creativity demonstrated through different forms of assessment of learning that has occurred. Resources relate to physical resources e.g. physical space, ability to photocopy handouts, simulated materials and to human resources e.g. other professionals or people with diabetes that are able to contribute to the Programme. Trained Educator The APEDS identifies the knowledge, skills and attitudes required of a trained educator. Each person identified as involved in the delivery of education is required to provide evidence of how they meet these. The Educational Lead is required to meet all aspects. Those who are not Educational Leads are required to evidence only the last six aspects (APEDS & TAPEDS page 3). Participants are encouraged to submit any other evidence of peer reviews, external assessment or self reflection. Quality Assurance The purpose of quality assurance is to determine that the best possible educational opportunities are offered to people with diabetes. In itself, it is a process of which the whole APEDS is part. For the submitted Programmes, quality assurance relates to where and how written or electronic records are retained regarding: patient education; any evidence of patient evaluation forms of the Programme; any peer review or self reflection on the ability of the educational providers to teach others. Audit This area is divided into three sections: patient, professional and organizational aspects. Patient aspects There are a variety of tools used to assess quality of life. Some Programmes use nationally recognised questionnaires e.g. Hospital Anxiety and Depression Scale (HADS), or the Problem Areas In Diabetes (PAID). Others might use questioning as a way of assessment. If the Programme is directed at people below the age of 18 years, there might not be any formal assessment method used. There is a lack of valid and reliable tools to assess quality of life with young people. If the Programme, for people below the age of 18 years, attempts to assess quality of life, please record what is used for this purpose. Some Programmes may assess quality of life in an anonymous manner and so no individual action can be taken. Some will assess quality of life before the Programme and then at a time period after the Programme has been completed. At this stage, it is important to capture what is being done as there are no particular recommendations being made. Any attempts to assess people with diabetes knowledge and skills, pre and post education are to be recorded. In some ways, this is a continual process which will be evident through how individuals engage verbally with the health care team and how their behaviours relate to what has been taught. There can be literacy problems that prohibit the use of questionnaires and this may be assessed normally through verbal questioning. Reviewers are encouraged to 6 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

recognize the expertise of the health care team in assessing individual s knowledge and skills. While it is recognized that education is one tool necessary for learning and implementing into practice, it is only the individual living with diabetes who can actually implement learning into behaviour change. All Programmes are encouraged to promote behaviour change towards self care management and one element within this is an individual s confidence to make those changes. Therefore, confidence to make changes should be assessed. Coupled with this, the Programme should provide evidence about how behaviour change is actually assessed. Using Kirkpatrick s model above, it may be that this form of assessment is more longitudinal and is undertaken by observing behaviours rather than attempting to measure the intention to behave in certain ways. Self-management of people with diabetes is crucial for long term health benefits. The Programme should provide evidence of how this is assessed. This may be through reflecting on a situation or the development of an action plan arising from a clinical situation. There will be variety in how this is done and reviewers are encouraged to embrace variations in this element. The views of people attending educational Programmes or sessions are crucial. Programmes should present different ways in which participants views are determined. This may be by a questionnaire, verbal questioning, or informally through word of mouth. Normally, people will respond if they have benefitted from the education but may be reluctant to give feedback when it is their own health care professionals who are delivering the education. Reviewers need to be cautious in their own interpretations of Programme reviews. The Educational Lead for the Programme thereafter needs to demonstrate what actions have been taken as a consequence of participants responses. Examples may be a: brief written statement of intent to alter who contributes to a Programme; statement about changing a venue to make it more accessible to others; statement about changing the method of educational delivery. Professional aspects Programmes are required to demonstrate how those who contribute to it are evaluated by participants. This element may be integrated into the audit section above and reviewers may need to scrutinize evaluation forms etc. before they find the relevant evidence. Programme providers are encouraged to peer review each other although this is not always practical. Peer review, including undertaking it and giving constructive feedback is a skill that health care professionals are encouraged to learn. Where professionals undertake peer review of each other, there may not be the requirement for them to also undertake personal reflection on their teaching. Reflection is part of the feedback integrated into peer review. Therefore, this part of the process could be an either/or scenario as opposed to both. All health care professionals are encouraged to reflect on their practice but not all will maintain a written record of this. Written reflections may use a template, derived from two national professional development Programmes 3, 4 or it may take the form of a diary or similar account. As these reflections AUDIT 7

are personal to the health care professional, individuals will not be asked to submit the actual account but rather state if they have undertaken reflection or not. Organisational aspects In submitting Programmes for review, the Educational Leads are expected to submit the numbers of people who attended the Programme and the completion rates. Any accessibility issues should be identified. These may include physical aspects e.g. the computer for presenting material did not work; literacy issues e.g. the Programme was prepared for adults who could speak English but there were a higher proportion of people attended for whom English was not their first language. The curriculum of educational Programmes should be reviewed every second year as a minimum. The date of the last review of the curriculum should be recorded and noted. Programmes are required to meet 80% of the criteria to be acknowledged as meeting the requirements for recording on SCI-Diabetes. The essential criteria are identified with an asterisk *. References 1. Bath L (2009) Short Life working group of type 1 diabetes. Scottish Diabetes Group, Edinburgh http://diabetesinscotland.org.uk/ Publications/Final%20report%20of%20 the%20type%201%20diabetes%20 Short%20Life%20Working%20Group.pdf 2. Tamkin P, Yarnall J, Kerrin M (2002) Kirkpatrick and Beyond: A review of models of training evaluation. The Institute of Employment Studies, Brighton 3. NHS Education for Scotland Flying Start http://www.flyingstart.scot.nhs.uk 4. NHS Education for Scotland Effective Practitioner http://www.effectivepractitioner.nes. scot.nhs.uk/learning-and-development/ clinical-practice.aspx 8 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Appendix 1 SCI-Diabetes Descriptors for recording patient education These descriptors have been agreed by the Scottish Diabetes Education Advisory Group for recording patient education onto SCI-Diabetes. Type 1: Level 1 The patient, at diagnosis, participates in an education programme provided by a suitable qualified health professional that addresses the core skills required to survive and to begin making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Insulin: its action, how to administer, store; How to self monitor blood glucose The place of ketones Basics of diet Cause, diagnosis, treatment and prevention of hypoglycaemia Cause, diagnosis, treatment and prevention of diabetic ketoacidosis including the sick day rules Assessment of smoking status NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet Type 1: Level 2 The patient participates in an ongoing education programme provided by suitably qualified health professionals that addresses the needs of the individual to make life style changes and supports self management in living with diabetes. The patient education delivered meets the NICE criteria. Examples of curriculum content: Carbohydrate counting More in-depth hypoglycaemia More in-depth hyperglycaemia Exercise Insulin dose adjustment School/College/University/Employment issues Driving Alcohol Insurances Foot health education Benefits of clinic attendance Eye screening How to avoid diabetes complications Travel and holidays Sexual health Psychological issues APPENDIX 1 9

Type 1: Level 3 The patient participates in an education programme provided by suitably qualified health professionals that is part of a programme addressing specific aspects of self management that will support the patient making life style changes to live with diabetes. Level 3 programmes are recognized as structured patient education programmes and meet the NICE criteria. Examples of such programmes are DAFNE and Intensive Insulin Therapy. Type 2: Level 1 The patient, at diagnosis, participates in an education programme provided by a suitably qualified health professional that addresses the core skills required to begin making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Basics of diet Anticipated future treatment options Oral hypoglycaemic agents: when to take, expected side effects, what to do if unwell Planned monitoring Assessment of smoking status NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet Type 2: Level 2 The patient participates in an ongoing education programme provided by suitably qualified health professionals that addresses the needs of the individual to make life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Examples of curriculum content: Carbohydrate counting More hypoglycaemia dependent on oral hypoglycaemic agent Exercise Employment issues Driving Alcohol Insurances Foot health education Benefits of clinic attendance Eye screening How to avoid diabetes complications Travel and holidays Sexual health Psychological issues Type 2: Level 3 The patient participates in an education programme provided by suitably qualified health professionals that is part of a programme addressing specific aspects of management that will support the patient making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Level 3 programmes are recognized as structured patient education programmes. 10 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Examples of such programmes are DESMOND, Weight reduction programmes, Long term conditions self- management programmes. Gestational Diabetes: Level 1 The patient, at diagnosis, participates in an education programme provided by suitably qualified health professionals that addresses the core knowledge and skills for diabetes management during pregnancy and the post-partum period. The patient education delivered meets the NICE criteria. Core skills identified are: How to self monitor blood glucose Basics of diet Assessment of smoking status NHS/DUK help lines Identification e.g. card or bracelet They may also include: Insulin: its action, how to administer, store; The place of ketones Oral hypoglycaemic agents: when to take, expected side effects, what to do if unwell Cause, diagnosis, treatment and prevention of hypoglycaemia Cause, diagnosis, treatment and prevention of diabetic ketoacidosis including the sick day rules Social Security benefits Maturity Onset Diabetes of Youth: Level 1 The patient, at diagnosis, participates in an education programme provided by suitably qualified health professionals that addresses the core skills required to begin making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Basics of diet Anticipated future treatment options Oral hypoglycaemic agents: when to take, expected side effects, what to do if unwell Planned monitoring Assessment of smoking status NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet Latent Autoimmune Diabetes of Adulthood: Level 1 The patient, at diagnosis, participates in an education programme provided by a suitable qualified health professional that addresses the core skills required to survive and to begin making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Insulin: its action, how to administer, store; How to self monitor blood glucose The place of ketones Basics of diet APPENDIX 1 11

Cause, diagnosis, treatment and prevention of hypoglycaemia Cause, diagnosis, treatment and prevention of diabetic ketoacidosis including the sick day rules Assessment of smoking status NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet Maternally Inherited Diabetes and Deafness: Level 1 The patient, at diagnosis, participates in an education programme provided by suitably qualified health professionals that addresses the core skills required to begin making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Basics of diet Anticipated future treatment options Oral hypoglycaemic agents: when to take, expected side effects, what to do if unwell Planned monitoring Assessment of smoking status NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet Neonatal Diabetes (Permanent): Level 1 The neonate s parents/carers participate, at diagnosis, in an education programme provided by a suitable qualified health professional that addresses the core skills required to survive to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Insulin: its action, how to administer, store; How to self monitor blood glucose The place of ketones Basics of diet Cause, diagnosis, treatment and prevention of hypoglycaemia Cause, diagnosis, treatment and prevention of diabetic ketoacidosis including the sick day rules NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet Pancreatic Pathology: Level 1 The patient, at diagnosis, participates in an education programme provided by a suitable qualified health professional that addresses the core skills required to survive and to begin making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Insulin: its action, how to administer, store; How to self monitor blood glucose The place of ketones Basics of diet 12 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Cause, diagnosis, treatment and prevention of hypoglycaemia Cause, diagnosis, treatment and prevention of diabetic ketoacidosis including the sick day rules Assessment of smoking status NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet Secondary - Drug Induced: Level 1 The patient, at diagnosis, participates in an education programme provided by a suitable qualified health professional that addresses the core skills required to survive and to begin making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Insulin: its action, how to administer, store; How to self monitor blood glucose The place of ketones Basics of diet Cause, diagnosis, treatment and prevention of hypoglycaemia Cause, diagnosis, treatment and prevention of diabetic ketoacidosis including the sick day rules Assessment of smoking status Role of drugs including alcohol NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet Secondary Disease: Level 1 The patient, at diagnosis, participates in an education programme provided by a suitable qualified health professional that addresses the core skills required to survive and to begin making life style changes to live with diabetes. The patient education delivered meets the NICE criteria. Core skills identified are: Insulin: its action, how to administer, store; How to self monitor blood glucose The place of ketones Basics of diet Cause, diagnosis, treatment and prevention of hypoglycaemia Cause, diagnosis, treatment and prevention of diabetic ketoacidosis including the sick day rules Assessment of smoking status Role of drugs including alcohol NHS/DUK help lines Social Security benefits Identification e.g. card or bracelet APPENDIX 1 13

Appendix 2 Review of Structured Patient Education in Diabetes in Scotland General Aspects Health Board Date received Date reviewed Date submitted comments to relevant person Name of Programme* Name of Educational Lead* National Course with modifications Yes No Details of modifications* Intended patient group* How identify learning needs?* Self-referral Referred by professional/other Other means: (please list) Programme participants names submitted* Yes No Professional qualification Yes No Comment Job title Yes No Comment 14 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Where educational resources retained* Accessibility of educational resources* Dates of delivered programme* Venue* NHS site Private sector Telemedicine Patient s home Other (please list) Philosophy of the programme Philosophy present* Yes No Were people with diabetes involved in its development? Yes No If yes: how? If no, why not? Does it support self management? * How is it shared? Yes No APPENDIX 2 15

Curriculum Educational theory* Evidence based course content* Aims and outcomes for each session* Lesson plan for each session Appropriate learning activities* Yes Yes Yes Yes No No No No Assessment of learning* Verbal Written Demonstration Other (please list) Resources used* Trained Educator: to be completed for each person teaching on the programme Writing a philosophy Writing aims and learning outcomes Identify training and educational opportunities Identify patient and carers learning and development needs 16 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Develop educational session Deliver educational session* Prepare and use visual aids* Teach a skill* Manage group education* Evaluate learning* Improve learning and development provision* Develop own learning abilities* Evidence of additional skills Is mentorship required? Yes No If yes, what is the evidence? * Any further evidence? APPENDIX 2 17

Quality Assurance How are records retained of patient education?* Written Electronic Both Where are records retained of patient education?* Have any patient evaluation forms been submitted? If Yes: what is overall summary? * Yes No What evidence has been submitted on peer review/ evaluations to teach others? * What is the summary of peer review etc* Audit: Patient aspects Is quality of life assessed? Yes No If Yes: how?* What action is taken after QoL assessment?* What attempts made to continually assess patients knowledge and skills pre and post? Is confidence to change behaviour assessed? If Yes: how?* Yes No Is behaviour change assessed? Yes No If Yes: how?* 18 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Is self management assessed? Yes No If Yes: how?* How are participants views of the programme captured?* What actions are taken in light of the reviews?* Audit: Professional aspects How are educators evaluated by participants?* Is peer review undertaken? Yes No If Yes, How?* If No, why not? Is there evidence of self reflection?* If Yes, How?* Yes No If No, why not? APPENDIX 2 19

Audit: Organisational aspects Number of people invited to attend* Number who attended at the start* Number who completed* Any accessibility issues identified? Yes No If yes, what were they? Date of last review of curriculum and is this within the last 2 years?* Date: Yes No 20 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Appendix 3 Reporting template for acceptable Programmes Please submit this form to the Scottish Diabetes Education Advisory Group Health Board Name of Programme Name of Educational Lead Name of Lead Reviewer Profession/Person with Diabetes Date of report I am writing to inform the Scottish Diabetes Education Advisory Group that the above Programme has been reviewed and has been deemed to meet the requirements of structured patient education. This is appropriate for people with (NAME type of diabetes from SCI-Diabetes list) and at level (NAME level from SCI-Diabetes list). Name of 2 nd Reviewer Profession/Person with Diabetes Name of 3 rd Reviewer Profession/Person with Diabetes APPENDIX 3 21

Appendix 4 Reporting template for minor adjustments to the Programme Please submit this form to the Scottish Diabetes Education Advisory Group Health Board Name of Programme Name of Educational Lead Name of Lead Reviewer Profession/Person with Diabetes Date of report I am writing to inform the Scottish Diabetes Education Advisory Group that the above Programme has been reviewed and the Educational Lead is to be asked to make minor amendments to the Programme and to resubmit it for further review before it is deemed to meet the requirements of structured patient education. Aspect Philosophy Curriculum Trained Educator Quality Assurance Audit Minor adjustment Name of 2 nd Reviewer Profession/Person with Diabetes Name of 3 rd Reviewer Profession/Person with Diabetes 22 Reviewers Handbook for Assessment of PATIEnt Education in Diabetes in Scotland (APEDS)

Appendix 5 Action plan template Please submit this form to the Scottish Diabetes Education Advisory Group Health Board Name of Programme Name of Educational Lead Name of Lead Reviewer Profession/Person with Diabetes Date of report I am writing to inform the Scottish Diabetes Education Advisory Group that the above Programme has been reviewed and the Educational Lead is asked to compile an action plan to amend the Programme and to resubmit it for further review before it is deemed to meet the requirements of structured patient education. Aspect Philosophy Curriculum Trained Educator Quality Assurance Audit Key issues to be addressed Action plan to be completed by Educational Lead Name of 2 nd Reviewer Profession/Person with Diabetes Name of 3 rd Reviewer Profession/Person with Diabetes APPENDIX 4/5 23

Different format required? This resource can be made available, in full or summary form, in alternative formats and community languages. Please contact us on 0131 656 3200 or email altformats@nes.scot.nhs.uk to discuss how we can best meet your requirements. Published Winter 2012 NHS Education for Scotland Westport 102 West Port Edinburgh EH3 9DN Tel: 0131 656 3200 www.nes.scot.nhs.uk