Staff on ward 10 West10 West are celebrating this month after becoming the first diabetes improvement pilot ward at the trust. A number of new interventions on the ward to improve diabetes management and patient safety are now showing excellent results.

As part of our patient safety programme (PSP), diabetes care is a key work stream and high priority for the Royal Free London. The 10 West diabetes improvement pilot began a year ago, following a serious incident on the ward. Using a collaborative approach with improvement methodology, front line staff were empowered to help make changes to their clinical area. Recommendations were then made to address issues from the serious incident including improved recognition and escalation treatment of hyperglycaemia (high blood sugars levels).

Caitriona Stapleton, patient safety programme manager, said: “An improvement team was formed using a multi-disciplinary approach including patient safety staff, 10 West's matron and ward champions, a diabetes consultant and lead nurse, members of the patient at risk and resuscitation team (PARRT), pharmacists, a dietician and biochemistry staff.

“With this expertise we were able to develop a hyperglycaemia management pathway which was tested using improvement science methodology plan, do, study, act (PDSA), and small tests of change on the ward. As part of the pathway, clearer guidance around increasing diabetes medications, including insulin, was created. A separate pathway focusing on recognition and treatment of low blood sugars (hypoglycaemia) was tested in a similar format.”

Other key improvements from the pilot include:

  • testing of a hypoglycaemia box
  • new dosing guidance for increasing diabetes medication
  • new insulin table guidance
  • new colour coded blood sugar charts 
  • a new diabetes in-patient booklet
  • new simplified alerts from glucometers to help staff recognise and escalate patients for early review.

Data so far has demonstrated that there is increasing compliance with using both pathways and patients are having more timely control with abnormal blood sugars. The next phase of work is reviewing the impact of the pathways on patient outcomes such as length of stay reduction, and also capturing patient feedback on their experience.

With ward data now being collected by the diabetes nurse champions, instant feedback is being used to plan further changes. The multi-disciplinary approach has shown earlier identification of high risk patients, better recognition, escalation and management by ward staff and improved diabetes awareness and safety on 10 West.

Clare Carter Jones, 10 West cardiology matron, said: “We are really proud of being a part of this work; it has enabled us to step up and take ownership of a problem that we faced and as a consequence improve our safety culture just by showing what we can achieve with the right support. I’m particularly proud of our champions, Will Koppel, Liz Harding and Catriona O’Neill who have worked incredibly hard.”

A second pilot ward is being planned and will be confirmed over the next few weeks.

James Mountford, director of quality, said: “The diabetes work on 10 West is an excellent example of continuous quality improvement in action, benefiting both patients and staff. It involves staff collaborating with patients, learning and applying a method to discover how to drive better results in what matters most to patients. The trust's quality strategy, currently in development, puts continuous improvement and the support required to achieve it at the heart of how we work, trust wide.”


Image: Staff on ward 10 West at the Royal Free Hospital

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About the Royal Free London NHS Foundation Trust

The Royal Free began as a pioneering organisation and continues to play a leading role in the care of patients. Our mission is to provide world class expertise and local care. In the 21st century, the Royal Free London continues to lead improvements in healthcare.

The Royal Free London attracts patients from across the country and beyond to its specialist services in liver and kidney transplantation, haemophilia, renal care, HIV, infectious diseases, plastic surgery, immunology, Parkinson's disease, vascular surgery, cardiology, amyloidosis and scleroderma and we are a member of the academic health science partnership UCLPartners.

In July 2014 Barnet Hospital and Chase Farm Hospital became part of the Royal Free London. Read 'A bigger trust, a better future'.