NHS England | March 2019 | Improving insulin administration in a community setting
Specialist Diabetes nurses have led on the development and implementation of a new, modular training programme for both community nurses and non-registered practitioners in diabetes care.
Diabetes specialist nurses found variation in diabetes care in both the community and in residential care homes, with increased demand for district nurses to administer insulin.
They identified an opportunity to implement insulin delegation- the process by which a registered nurse allocates the task of insulin administration to a named, competent, non-registered practitioner, such as a healthcare assistant. An insulin delegation programme involves:
- Developing an insulin delegation policy, and updating other relevant policies and procedures;
- Assessing the diabetes knowledge and skills of everyone involved in diabetes care, including registered nursing staff;
- Theoretical and practical training for all staff who require it, and additional training for staff administering insulin;
- Competency assessment, mentoring and support for those administering insulin.
Specialist diabetes nurses carried out a detailed audit to establish the level of diabetes knowledge amongst community nurses and identify areas where delegation could be considered. An audit was undertaken by registered community nurses, this underlined opportunities for upskilling colleagues in relation to insulin therapy, illness management, nutritional management and footcare.
The training programme that was developed comprises three modules:
- Diabetes awareness
- Expansion of diabetes knowledge
- Insulin administration for non-registered practitioners
Some of the community staff became diabetes mentors for the programme, the mentors also participated in the same training course as the non- registered practitioners.
This programme led to better use of resources:
The insulin delegation programme offers a way of supporting complex care by providing skill and competency development, supported by robust governance infrastructure. Non-registered practitioners can administer diabetes care, including insulin, while still under the supervision of a community nurse, ensuring patient safety and quality of care. Community nurses can be released to support other patient groups. There is now improved diabetes care planning with the use of non-registered practitioners to support their own clients in residential care home settings, reducing the need for, and frequency and number of, district nurse visits, especially in rural locations ( Source: NHS England).