157 A clear call for consistency: creating a working document for management of diabetes in palliative care patients
Diabetes affects a significant proportion of our patients, with a higher prevalence than the UK population (6%) due to those with steroid induced and disease related diabetes. This can present both symptomatic challenges and regimen burden, which can require the patient to accept changes that may be at odds with their established management. In the hospice in patient setting a lack of consistency of clinical approach to diabetic patients was observed, due to part time working, a varied medical
... , a varied medical team and the perceived complexities of diabetic management in this patient group. Whilst a guideline existed, it was held away from the patients' bedside and not consistently reviewed. A new set of 'working documents' was created, based on the existing evidence, held at the patient's bedside. This 2 sided document contains detailed guidance on medical management dependent on prognosis, and incorporates monitoring charts for nursing staff; aiding consistency of approach and clarity of decision making. We audited the use of the form, both before and after education sessions to support its use, with an aim to make any necessary improvements. Methods We audited 20 diabetes forms both pre and post educations sessions. These involved staff confidence scores pre and post education, and then discussion around the use of the forms. Results Following the education sessions, the number for forms correctly filled in increased from%5 to 30%. Confidence scores of staff users also increased significantly from 6.8/10 pre education, to 8.7/10 post education. General feedback was sought and incorporated where appropriate. Conclusion A clear improvement was noted in the use of the forms following staff educations sessions, which has positively impacted a new, cohesive MDT approach to improving diabetes management.