Priscilla Wakefield House (PWH), a 117 bedded nursing home in East Haringey, North London, provides care for younger adults and older persons with a variety of needs. In March 2019, PWH became part of the Care England/Foundation of Nursing Studies Teaching Care Homes (TCH) Programme.
The population of East Haringey is very diverse; many of the local residents are of black African or black Caribbean descent, with a smaller number of Asian descent. This diversity is of relevance to PWH as the prevalence of type 2 diabetes is approximately three to five times higher in minority ethnic groups in the UK than in the white British population (Goff, 2019).
To bring integrated diabetes care as close to home as possible, the team at PWH adopted a whole staff team approach; and built and strengthened relationships with partners across health and social care including members of the Diabetic Nurse Specialist (DNS) team and local GPs.
An initial review revealed that:
- Approximately 50% of residents were living with diabetes
- HbA1c tests (the average blood glucose level over time) showed minimal improvements
- Information relating to the diabetic care of residents wasn’t always consistent or accessible
Firstly, the team developed a more robust system for storing and sharing information about persons with diabetes. Information about blood results, medications, date and outcomes of foot and eye checks etc. are now stored in one place and can be accessed by and communicated across the care home team and integrated system, ensuring that individuals receive the correct care in a timely manner.
Working with the DNS team and the local GP, a training programme was developed and delivered to 112 members of staff including nurses, care staff and also the catering team. The training and assessment of competence was based on the TREND-UK competency framework (TREND-UK, 2015). Training is ongoing as it forms part of the induction process for new members of staff.
The registered nurses received additional training enabling them to undertake the recommended annual ‘foot checks’ for persons living with diabetes. The mobile diabetic eye screening service now visits the home, rather than residents having to travel to hospital.
Finally, implementation of the new knowledge and skills has been supported by the development of Standard Operating Procedures. This has enhanced staff confidence in decision-making when managing the care of persons living with diabetes and also caring for persons experiencing hypo- or hyperglycaemia. The protocols have been shared widely. Further, care for individuals is now reviewed at least every three months by a GP and a Matron from the Community Health Assessment Team.
A number of interrelated positive impacts from this work have been identified.
- The nursing home team are moving very close to providing a nurse-led diabetes service for all those living in the home with diabetes
- Staff competence and confidence in detecting and managing hypo- and hyperglycaemic attacks is enhanced, and they are now also caring for persons with more complex diabetes care needs
- There has been a reduction in the frequency of hypo- and hyperglycaemic episodes, and there has been a reduction in HbA1c levels for most of the persons living with diabetes within the home
- Relationship building has resulted in greater integration across primary, community and secondary services
- No residents have visited A&E or been admitted to hospital for diabetes care from PWH over the last 12 months
As well as enhancing care experiences for residents, this project has created associated efficiency savings across the system.
The team want to continue their work, aiming to be fully self-sufficient for diabetic screening. They also want to share their learning and support others across the social care sector by creating a diabetic care forum.
A full report can be accessed at: https://www.fons.org/resources/documents/Teaching-Care-Homes/CE-FoNS-TCH-PWH-Enhancing-Diabetes-Care-Dec2020.pdf
Diabetes UK (2010) Good Clinical Practice Guidelines for Care Home Residents with Diabetes. London: Diabetes UK. Available from: https://www.diabetes.org.uk/resources-s3/2017-09/Care-homes-0110_0.pdf. Last accessed 10th December 2020.
Goff, L.M. (2019) Ethnicity and Type 2 Diabetes in the UK. Diabetic Medicine. Vol. 36. pp. 927-938.
Haringey Council (2020) Draft Health and Wellbeing Strategy. Slides for Discussion. Available from: https://www.haringey.gov.uk/sites/haringeygovuk/files/draft_hwbb_140820.pdf. Last accessed 15th December 2020.
Trend-UK (2015) An Integrated Career and Competency Framework for Diabetes Nursing
https://trenddiabetes.online/wp-content/uploads/2017/02/TREND_4th-edn-V10.pdf (Last accessed 17th December 2020).