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Inpatient Management of Diabetes Mellitus

Building Capability in Inpatient Diabetes Management

As part of the NSW Diabetes Taskforce has developed a capability program to support junior medical officers and nursing staff care for people with diabetes in hospital. In particular, those people requiring insulin. In doing so, the program aims to improve outcomes and experience of hospitalisation, as well as reduce clinical variation and  complications secondary to poor glycaemic control (hyper and hypoglycaemia).

Clinicians will have access to:

  • a clinical decision support app ‘Thinksulin’ to support point of care decision making
  • an eLearning program on My Health Leading with three learning modules will be available in the first phase
  • QStream a spaced training tool to reinforce learning from the eLearning program.

Why has the program been developed?

Glycaemic instability is commonly observed amongst inpatients with diabetes. Patients with diabetes are frequently admitted to hospital for treatment of conditions other than the diabetes. Therefore, insulin orders, administration and glycaemia management is the responsibility of general ward clinicians (including nursing staff and junior medical officers), not just endocrinologists or in-hospital diabetes services.

In addition, insulin is a high risk medication1. Error rates with insulin are not necessarily higher than with other medicines, but when problems do occur the consequences can be severe. The ACI Endocrine Network’s NSW Adult Subcutaneous Insulin Prescribing Chart aims to enable standardisation of insulin management across NSW. However, a 2015 evaluation of the chart in four local health districts showed a 'lack of awareness and understanding about components of current best practice in the management of people with diabetes outside of specialist endocrinology units', suggesting that best practice insulin management is not occurring in NSW hospitals2.

Components

Thinksulin - A Clinical Decision Support App

What is it?

A point of care app that will provide information and decision support on blood glucose level targets, hypoglycaemia management, blood glucose monitoring, basal-bolus calculations, and charting and reviewing doses.

Who is it for?

Targeted towards Junior Medical Officers and nursing staff (without specialist skills/knowledge in diabetes management); although it can be used by any clinician responsible for the prescription and administration of insulin.

How can you access it?

The App 'Thinksulin' is available for free on the AppStore and Google Play.

Download the Thinksulin flier (pdf 419KB)

eLearning Modules

What is it?

A series of videos and online learning modules found on My Health Learning. Topics include: insulin basics; managing hypoglycaemia, and safely prescribing and administering insulin. Each module takes 15-20 minutes to complete.

Who is it for?

Targeted toward Junior Medical Officers and nursing staff; can be used by any clinician responsible for the prescription and administration of insulin.

How can you access it?

NSW Health Staff can access the modules via My Health Learning:

Non-NSW Health can access the modules staff via the ACI website:

Download the eLearning modules flier (pdf 414KB)

QStream Solution

What is it?

Spaced training with real-time feedback to reinforce the learning from the eLearning modules, incorporating gaming components.

Who is it for?

It is specifically targeted toward Junior Medical Officers or nurses that complete online learning or use decision-support app.

How can you access it?

QStream will be delivered via a smartphone app for users that complete the eLearning modules or sign up through the decision support app.
Access Inpatient Management of Diabetes Mellitus course

Download the QStream flier (pdf 226KB)

References

  1. Clinical Excellence Commission, Medication Safety and Quality: High Risk Medications. Available at: http://cec.health.nsw.gov.au/patient-safety-programs/medication-safety/high-risk-medicines. Accessed (16 January 2016).
  2. O’Connell Advisory (2015), Agency for Clinical Innovation Evaluation of the Subcutaneous Insulin Prescribing Chart in Four Local Health Districts, Final Report.
Read more about the Leading Better Value Care Inpatient Management of Diabetes Mellitus initiative