More than 4.9 million people in the United Kingdom (UK) have diabetes (Diabetes UK, 2021). All adults with Type 1 diabetes and some with Type 2 diabetes are reliant on insulin treatment to manage their condition. The number of older, frail, and co-morbid people with diabetes requiring insulin therapy is also increasing and some are reliant on community services in the provision of this crucial intervention (IDF, 2013). This has resulted to an additional pressure to the already overstretched District Nursing workloads, especially on the background of the COVID 19 pandemic. To manage this demand, appropriately trained and competency assessed health and care workers (HCW) including health support workers and healthcare assistants were identified to perform this delegated task, insulin administration, to those people with diabetes (PWD) whose control is stable.
Joint working led by East Sussex Healthcare NHS Trust with Sussex Community NHS foundation Trust, resulted to the drafting of a guideline to build upon the successful insulin delegation in care homes and District Nursing pilot carried out in October 2019 which covered the delegation to appropriately trained HCWs in Residential/Care Homes to administer insulin using pens to adult persons with diabetes (PWD) in the community who have either Type 1 or Type 2 diabetes. This also helped influence key stakeholders in agreeing a governance and accountability structure. We aim to present the outcomes of this pilot and the learnings and recommendations derived.
As a result of this pilot, we have been able to develop a full guideline which is fit for local use and adheres to the best practices described by NHSE. Owing to our experience in this area, we have been able to adjust the suggested voluntary framework to ensure it is practically fit for purpose. The success of our local pilot enabled buy in for key stakeholders and much needed reassurance in terms of risk management enabling us to quickly take up the NHSE voluntary framework and obtain governance and accountability sign off through our local trust.
Through working closely with our key stakeholders from the outset of this pilot, we were able to overcome challenges that others have struggled with mainly around governance processes. This has prevented several neighbouring areas for getting this work off the ground. We learnt early on that it was vital to engage our Head of Community Nursing employed by East Sussex Healthcare- the organisation who supplies Community Nurses. Without this buy in, spread and subsequent roll out of the pilot would not have been possible.
