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A series of national resources aims to improve diabetes management for older people transferred to care homes
Care home residents with diabetes are extremely vulnerable and have challenging medical and nursing needs. About one in four care home beds and one in six hospital beds are occupied by someone with diabetes. It is therefore important that care homes work to prevent avoidable hospital admissions, particularly where a person has comorbidities such as frailty and dementia.
Nursing Older People. 35, 5, 14-15. doi: 10.7748/nop.35.5.14.s5
Published: 03 October 2023
National Advisory Panel on Care Home Diabetes (NAPCHD) member and nurse Jo-Anne Wilson has put together this guide on the NAPCHD’s latest recommendations about managing diabetes in care home residents.
How has diabetes care changed in care homes?
The options and treatments for people living with this long-term condition have increased and become more individualised over the past decade.
Often people moving into care, particularly after the disruption to healthcare caused by the COVID-19 pandemic, have not had regular reviews or health screening, and nurses working in care homes should have an understanding of the new approaches, medications and technology in use.
What is the most recent national guidance for diabetes care for residents in care homes?
In 2022 the NAPCHD published a set of resources aimed at enhancing the quality of diabetes care, leading to improvements in well-being, quality of life and clinical outcomes for all residents with diabetes. And in March 2023 it published a position statement outlining the ‘significant shortfalls in diabetes care at a local level’ that became apparent in the COVID-19 pandemic.
The initial lack of technology, communication failures and poor monitoring highlighted the need for improved diabetes care. Previous national guidance did not appear to have been embedded across care homes nationally, leaving staff with low levels of awareness and a general lack of operational policies for diabetes.
How can care home nurses use these recommendations to improve diabetes care?
The NAPCHD’s national resources set out sustainable and effective improvements that can be made to achieve high-quality diabetes care. The recommendations are designed to bring about a culture change, giving a new model of diabetes care in care homes, focusing on the training and development of care staff. The resources can be adapted for local use and staff can add specific instructions to make them person-centred, while still adhering to best practice principles.
The easy-to-use resources are set out as a pathway that equips staff to recognise symptoms and suggests how they can respond. The pathway can be used as an early intervention tool or alongside another escalation tool that indicates when there is a need to contact the GP or an outof-hours service.
How can nurses identify opportunities for improving diabetes care in care homes?
The recommended step-by-step approach to the treatment of hypoglycaemia has led to practical changes in the care home where I work, Galanos House. We have introduced a kit that provides a range of glucose products for use in cases of low blood sugar known as a ‘hypo box’ and there is a step-by-step guide in the box that staff can grab and go to use as a prompt.
As a care home manager, I have used the NAPCHD care home diabetes audit form (resource 8) to establish a baseline for our knowledge and practice. This highlighted areas for development and demonstrated where good practice was already in place.
Where can nurses find out more about diabetes assessments?
The NAPCHD’s resident’s diabetes passport and shared care record (resource 9) can be used as an effective assessment tool. It can include the resident’s goals about food, foot care, health targets and a record of care. We have found this particularly useful when working with residents who struggle with their diet and lifestyle. Working in partnership by discussing and agreeing goals gives the resident more control, which can often be lost when people move into long-term care.
Appendix B of the NAPCHD recommendations sets out a comprehensive set of assessment frameworks and tools that have come from national and international guidelines. Concentrating on the importance of person-centred assessments throughout, the guidance considers the complex needs and presentations of residents, assessing cognition and mood, frailty, skin integrity, feet, mobility, falls and nutrition, and the use of recognised assessment tools.
The following five ‘quick wins’ should enable care homes to begin to implement some of the National Advisory Panel on Care Home Diabetes (NAPCHD) recommendations:
1. Distribute Care Home Diabetes packs to all care homes in 2022-23
2. Create a sample diabetes-related pre-placement assessment form to be incorporated into existing templates used by local authorities and care providers
3. Ensure that all UK care homes receive a summary of the updated Trend Diabetes’ End of Life Guidance for Diabetes Care, which covers all the key actions required in managing end of life for residents with diabetes
4. Establish a ‘training and education pilot’ using the NAPCHD proposals for care staff in a group of care homes in agreement with owners and managers
5. The NAPCHD, working with national bodies and commercial companies, will produce a template for a minimum dataset of key diabetes indicators for inclusion into care homes’ generic records
Source: Diabetic Medicine (2023)
How can nurses work collaboratively with other healthcare professionals in relation to diabetes care?
Multidisciplinary working across the NHS and social care needs to be embedded. There are often gaps in transitional arrangements between the NHS and care homes – including failed discharges – which are often due to lack of resources.
The NAPCHD resources also contain a nutritional intervention schedule for residents with diabetes. Recommendations for the best diet for people with diabetes have changed dramatically in recent years, from a strict and rationed diet based on carbohydrates, proteins and fats to a balanced diet, low in saturated fat with lots of vegetables. The nutritional recommendations are from diabetes specialist dietitians with experience in the care home settings and are based on best clinical practice. They are useful not only for nursing and care staff, but also for chefs and catering teams in care homes.
For those care homes that struggle to get input from a community dietitian, this information will give chefs and nurses the confidence to know they are making the right choices for residents with diabetes. With mealtimes being such an important part of the daily routine in a care home, this could help to provide a positive experience.
How will diabetes care in care homes change in the future?
The NAPCHD advocates for a nurse-led service model supported by the local primary care network. Certainly, this model would work well with the Enhanced Health in Care Homes initiatives, which could provide funding and support from integrated care systems.
With Skills for Care producing a guide to delegated healthcare interventions in care homes, the NAPCHD resources could be used to underpin an integrated community approach to delegated diabetes care.
Other messages from the NAPCHD recommendations include:
» Staff training/development should include input from a specialist diabetes nurse and dietitian.
» The care home diabetes audit tool should be used to establish a baseline of knowledge and practice.
» The diabetes passport and shared care record are helpful tools for assessment and to establish care goals.
» The need for a hypo box with a guide on treating hypoglycaemia.
» The need for a diabetes care policy in individual care homes.
Diabetes UK (2022) Diabetes Care in Care Homes.
Diabetes UK: New Report – Making Hospitals Safe for People with Diabetes.
Diabetic Medicine (2023) Enhancing diabetes care for the most vulnerable in the 21st century: interim findings of the National Advisory Panel on Care Home Diabetes (NAPCHD). Diabetic Medicine. 40. 8. doi.org/10.1111/dme.15088
National Advisory Panel on Care Home Diabetes (2022) A Strategic Document of Diabetes Care for Care Homes.
Skills for Care (2022) Delegated Healthcare Activities.
Trend Diabetes (2021) End of Life Guidance for Diabetes Care.