Paediatric diabetes operational 1745.pdf - East Cheshire NHS Trust

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Patient InvolvementThere is an active Diabetes UK local support group. The PDSN attends the committeemeetings and most of the organised events.Treatment, Follow up and ScreeningNICE have developed guidelines for the management of a number of different aspects ofpaediatric diabetes care. The MDT has tried to implement these recommendations into ourworking practices. We endeavor to provide a service as detailed in the guidelines whereresources allow. The MDT work towards target HbA1c of 58 mmols/mol (7.5 %) whilerecognising that this target is often difficult to achieve.At diagnosis all new patients will be managed by the MDT at the earliest opportunity. Thiswill normally be on the day of admission or within the next 24 hours. It may not be possibleto meet this target at weekends or over Bank Holidays. Ward staff are encouraged tocontact Dr Chandrasekaran or Nicola Birtwistle about all new admissions and they will oftenbe able to provide advice even when not on call. Children will be seen by the consultant orPDSN within 24 hours of admission where possible or the next working day, and will begiven an appointment to see the dieticians within a week post diagnosis. At the time ofadmission young people will be investigated according to recommendations in the NICEguideline as incorporated into our local guidelines. Children who are well will be starteddirectly onto sub‐cutaneous insulin therapy. This will be multiple injection therapy fromdiagnosis. If patients are unwell at the time of admission they will be stabilised onintravenous treatment following the BSPED DKA protocol.During the initial admission the PDSN will commence a structured teaching programme andthis will be continued and completed following discharge. Our specialist dietician willdiscuss dietary issues with the family and young person including provisional advice oncarbohydrate counting and dose adjustment. Further discussions will take place at homefollowing discharge. Families will receive a lot of support at home following diagnosis withregular visits and phone contacts from the PDSN. These visits will continue until the PDSNand the families are happy with the initial management.Patients will be offered follow up appointments at least every 3 months in the clinic. Wherethe need arises patients will be offered earlier reviews either in the consultant or nurselead clinic. At each appointment we will review the young person’s progress and addressany issues that have arisen. Families will also be offered the opportunity of seeing a PDSNand a dietician at all clinics. Currently appointment times are every 20 minutes withadditional time available for nursing and dietetic review.At all outpatient clinics near patient testing will take place so HbA1C will be available for allpatients at the time of their appointments.Each clinic room is equipped with a computer that could enable the downloading of datafrom blood glucose machines and insulin pumps.The MDT follows guidance from NICE on screening. At least annually patients have an MOT.Bloods are obtained for coeliac antibodies at diagnosis. Thyroid functions will be monitoredin all patients annually. In addition, children over the age of 12 years will have their lipidlevels checked, a urine sample is collected for ACR measurements and a blood pressure isobtained. We also collect data on the young person’s HbA1c results and record anyadmissions over the last 12 months. Children over the age of 12 are referred to the districtscreening programme for annual retinal screening.We have the facilities to conduct continuous blood glucose monitoring if this is requiredwith access to our own monitor.For young people who are experiencing problems with their diabetes we will endeavor toChildren’s Diabetes MDT Operational Policy May 23, 2012 14
increase the frequency of their appointments and provide increased support with a view toimproving control. This will include home visits, visits to school and telephone support.The MDT offers a pump service to young people where it is felt that pump therapy isindicated. Currently we use the NICE guidelines to aid our decision making on when we canoffer pump therapy. The PDSN and the lead clinician have both attended a pump trainingcourse. We currently have 42 patients on insulin pumps.The service looks after a small number of young people who do not have classical type 1diabetes. We have patients with type 2 diabetes and diabetes associated with othersyndromes. We endeavor to make accurate diagnoses for all our patients and often liaisewith national or international experts for advice on the management of these moreuncommon types of diabetes.High HbA1c PolicyChildren that have HbA1c’s above 80mmol/mol (9.5%) are offered extra support andinterventions to help improve control. This is done in collaboration with the family andyoung person and an individual plan is negotiated. These plans may incorporate, troubleshooting, further diabetes education, insulin regimen change, more frequent contact viaphone, email, home visits etc, Continuous Glucose Monitoring,Teenagers with persistent high HbA1c’s who are not engaging with their diabetes treatmentare assessed to see if CAMHS referral is required.Currently in May 2012 the number of children and young people with an HbA1c above orequal to 9.5% is 23 which is 27% of the case load. The team recognises that this is a higherproportion than they would want. Increased resource to the team should help reduce thisnumber. The team will audit this number on a regular basis.DNA PolicyThe Diabetes team follows the trust paediatric DNA policy which incorporates safeguarding. A child with diabetes will never be discharged from follow up and every effort willbe made to engage the family and young person with services. If a child or young persondoes not attend or cancels a pre arranged clinic appointment, another time is given for thenext available clinic slot. If this is more than a month the PDSN will arrange to see the childsooner if this is required.The PDSN will aim to contact the child or young person to see if there are any specificproblems that may be preventing them from attending the clinics especially in the case ofregular non attendees. If the team has safe guarding concerns these will be discussed withthe named nurse for child protection.Escalation policyThe DKA and Safeguarding children policies give guidance on the how to escalate concerns,there is no specific escalation policy relating specifically to diabetes.Children’s Diabetes MDT Operational Policy May 23, 2012 15
Page 1 and 2: Paediatric and Adolescent Diabetes
Page 3: Table of contentsIntroduction……
Page 6 and 7: Purpose of the MDTThe aim of the MD
Page 8 and 9: and their carers.• Contributing t
Page 10 and 11: Membership Arrangements Members of
Page 12 and 13: The MDT MeetingsWeekly MeetingsWeek
Page 16 and 17: Adherence to GuidelinesThe MDT look
Page 18 and 19: Equality Analysis (Impact assessmen
Page 20 and 21: From the evidence available does th
Page 22: 7. Any actions identified: Have you

Paediatric diabetes operational 1745.pdf - East Cheshire NHS Trust

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