Title: Making Insulin Treatment Safer in Northern Irish Hospitals
Funder: Health and Social Care Research and Development Division (HSC R&D) of Public Health Agency, Northern Ireland

Abstract: PROBLEM/NEED: Roberta, member of our Team, says “If I had to be admitted to hospital, my main concern would not be my impending surgery… being used to having total control of my insulin regimen, my worry would be that this could be mis-managed”. Between one five and one in ten patients in British hospital beds have diabetes, many of whom receive insulin. You might think such a common disease would be skilfully treated but evidence shows not and patients in NI fare worse than elsewhere in the UK. The reasons are simple. When prescribing, doctors must choose from a confusing array of insulin types. Even after making the right choice, insulin can be lethal in unskilled hands. Yet prescribing insulin is delegated to the least experienced doctors. The culture of medicine makes it hard for them to admit their inexperience and ask for help. Many diabetic patients, on the other hand, are experts who could help if allowed to do so. This project addresses two problems: poor insulin treatment of diabetic patients in NI hospitals; and patients’ ability to have a say in their treatment. KNOWLEDGE EXCHANGE OBJECTIVES: The objective is to improve insulin errors by: 1) helping doctors in the first two years after qualifying (foundation doctors, abbreviated to FDs) learn from insulin errors; 2) giving patients a greater part in their own care; 3) developing a package, which could be sustained in the future. THE SOLUTION: Our Team, which has successfully improved FDs’ antibiotic prescriptions, wishes to transfer its knowledge onto insulin prescriptions. Our package of measures starts by encouraging FDs to learn two ‘mantras’: don’t fly solo till you’re competent. And, when you first feel uncertain or incompetent, don’t be afraid to ask whether, what, how, why, and when. We will empower FDs to ask patients, nurses, doctors, and pharmacists whether, what, how, why, and when questions and consult learning resources, which provide answers. We will supplement existing in-service education by auditing prescriptions for patients on insulin and feeding information back to FDs. In small group education sessions, a pharmacist, nurse, doctor, and patient will empower FDs to follow the mantras. FDs will make written commitments to change their clinical behaviour. The commitments will be to make best use of the expertise of other workers and information sources, involve patients more, and reduce errors. Through engagement activities, we will use this example to make members of the public aware of their right to have a say in their own care. IMPACTS: 1) Diabetic patients’ sense of involvement in their own care. 2) FDs’ educational experiences. 3) The quality of insulin prescriptions. 4) Members of the public’s awareness of their right to be involved in their care. EVALUATION: We will evaluate the impacts on patients, error rates, FDs, and members of the public using a combination of numbers (eg of error rates) and words (eg patient’s experiences of care).


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: METABOLIC AND ENDOCRINE