Optimising Transfer of Care to improve safety in diabetes care (2019)

Herefordshire CCG

Project Summary

Following the joint formulary update to assure cost-effective diabetes prescribing between secondary and primary care the CCG medicines optimisation team identified gaps in diabetes care/information provided across the healthcare system. One of the identified needs was to improve the timely, safe and accurate transfer of care information and medication requests to GP Practices from the Specialist Diabetes Team.

We pooled local intelligence i.e. outcomes of incidents, Patient Feedback, Patient Safety Alerts ,QIPP plans and formulary update information required to safely prescribe diabetes medicines, to improve support to Primary Care i.e. Practice Nurses, Pharmacists, Care Homes, to manage diabetes care effectively.

We developed a Specialist Diabetes Team “Transfer of Care Medication Request Form” to ensure: continuation of care, use of formulary items, reduce medication errors and improve patient safety on transfer of care.
The form:

• relays a brief written record of the consultation by the Specialist Diabetes Team via e-mail (instead of fax)
• ensures that insulins are accurately requested and prescribed by brand, with a record of insulin dose and advice on the correct quantities to supply per month
• helped to introduce biosimilar glargine where appropriate for new patients in line with formulary
• facilitates patients receiving cost effective prescription supplies, as per formulary, including insulin, needles, test strips, lancets, sharps bins
• informs practice staff of changes to medications and reasons i.e. stopped medicines, dose changes
• provides weblinks to other resources i.e. Sharps PIL, Prescribing Quantities, Insulin expiries.
  There were a number of additional outcomes from this joint work:
• After development of the adult form the paediatric team were keen to develop a form for young people and children
• The pharmacy technician involvement highlighted the need for organising deliveries of formulary supplies to promote use of correct products and assisting with maintaining supplies and storage, regular stock review of equipment to ensure inappropriate non-formulary devices have not been distributed by companies
• As new products have been added to the formulary practice staff training has been arranged to support implementation with CCG pharmacy technician support.

In conclusion the transfer of diabetes care form has brought together a number of joint initiatives to ensure patient safety in diabetes care which has:

• improved patient continuity through accurate transfer of prescribing information
• strengthened joint working across CCG Medicines Team, Diabetes Specialist Team, Hospital Pharmacy, Community Pharmacy, GP practices,
• this approach has allowed QIPP review to ensure cost effectiveness and has led to quality and patient safety initiatives
• It has highlighted the potential role of the pharmacy technician and further skill mix with pharmacy assistants across the health economy
• It has led to the recruitment diabetes secondary specialist pharmacist to continue medicines optimisation and patient safety in a high risk medicines area.

Medicines Optimisation Team & Specialist Diabetes Team
Herefordshire CCG & Wye Valley NHS Trust

The following information joint resources were developed and are available on the local web site: 

• cost effective needle prescribing
  Blood Glucose Monitoring in Care Homes
• producing guidelines on Blood glucose monitoring (BGM) for care home providers , outlining responsibilities for GP, Care Home manager, operator and Quality Control requirements
  Blood glucose monitoring (BGM) and Quality Control requirements for primary care providers update – i.e.
  
  • Internal Quality Control (IQC), External Quality Assessment (EQA), Quality Control procedures, training and annual updates (due to local contract changes)
  • Advice for practice staff to give to patients when updating Blood Glucose Meters
  • A checklist of point to explain to patients when updating their BGM meter
    Safe disposal of Sharps - Patient Information Leaflet
  • a patient information leaflet about the ordering, supply, use and safe return of sharps bins (ensuring safe disposal of sharps)
    Safety Needles
  • assisting the acute service with information and samples of safety needles with the vision to adopt one safety needle across Herefordshire.