Implementing a single system for diabetes blood glucose testing in a care home to optimise patient care (2025)

NHS Hertfordshire and West Essex ICB

Project summary

The Care Home Pharmacy Medicines Optimisation Team carried out a series of visits to a highly specialist 140 bedded neurological centre care home. The weekly visits were to tackle safeguarding concerns, inappropriate prescribing, ensure medications were being given as prescribed and according to ICB formulary and to introduce a multidisciplinary team approach to resident care. There were 22 patients in the home with diabetes none of whom were self-caring and 6 different systems for blood glucose monitoring were in use.

We agreed with the care home manager and GP that using one system would simplify care and make things safer for patients. This change would support the recommendations on using a cost-effective blood glucose monitoring system as advised from NHSE and on our local formulary. Using one system reduced waste, as following individual patient discussions and reviews not all residents required blood glucose testing and so we were able to stop unnecessary tests. We invited the manufacturing company of GlucoRx (one of our preferred brand of blood glucose monitor, lancets and test strips) to visit the home and train staff on its correct use. The changeover and training was completed on a single day.

Following an individual medication review and in collaboration with the GP we recommended stopping the practice of blood glucose testing for residents with stable type 2 diabetes and any unnecessary lancets/test strips for this use. In addition, we stopped any unrequired pen needles. In line with our local formulary, if long needles (lengths 8mm or 12mm) were being prescribed we changed them to a shorter length (6mm or less). Longer needles are items which should not routinely be prescribed in primary care (See: NHSE Items which should not be routinely prescribed in primary care). Where they were not required, test strips for ketone testing were also stopped. All interventions were discussed with patients, where they were competent, with the discussions focusing on the benefits of less testing and the use of more comfortable, shorter, needles. We provided residents and their families with written information about the change and the reasons why, to ensure they were informed and part of the decision-making process. 
This project helped us to reduce unnecessary spend, waste and bring prescribing in line with safe and cost-effective practices. It also simplified the systems in use in this home to one, which is much easier for care staff to use, be trained for and to understand. We recorded our cost-savings on the Coordinate Rx system which calculated a total saving of: £6,783 annual savings in 22 patients.