1Department of Diabetes and Vascular Medicine, Monash Health, Dandenong, VIC, Australia
Background
The number of patients newly diagnosed with Diabetes Mellitus (DM) or with pre-existing DM requiring commencement or change of insulin therapy is increasing. This has resulted in increased demand for ambulatory insulin stabilisation services provided by Diabetes Nurse Educators (DNEs) in the hospital outpatient setting.
Aim
To profile and review the efficiency of the Insulin Stabilisation Service for patients with Type 1 or Type 2 diabetes managed by DNEs in the Diabetes and Vascular Medicine Unit, Dandenong Hospital. Exclusion criteria were patients who were pregnant and requiring insulin stabilisation or managed with Continuous Subcutaneous Insulin Infusion (CSII).
Method
A Quantitative Retrospective Study Audit Tool was designed and utilised by project team members to collect data from 229 patient files who attended our Diabetes Centre from 1 September 2011 to 31 March 2012. Patient characteristics were compared by diabetes type using ANOVA for continuous variables and Chi-square test for categorical variables.
Results
Of the 229 patients referred to the insulin stabilisation service 113(49%) were men, 116(51%) women and of these 69(30%) were from non-English speaking background. The majority had Type 2 diabetes (n=189), while 30 individuals had Type 1 diabetes. Patient engagement is critical to the success of the service and we found that 192(84%) patients engaged with the service by either initiating phone contact or by being contacted by a DNE.
Implications
This audit has led to a proposed change in the insulin stabilisation service. Work has begun on a guideline for criteria of patients deemed suitable for this Service. Recommendations also include improved documentation for the scanned medical record and better communication between clinicians regarding discharge planning from the Service. Further research is required to establish why 37(16%) patients did not engage with this service and to establish predictors for those more likely to engage.