Hypoglycaemia care pathway
The aim of the project is to improve the care of patients living with diabetes (type 1 and type 2) by reducing avoidable episodes of severe hypoglycaemia, through increasing disease review and more effective aftercare following a ‘hypo’.
Episodes of severe hypoglycaemia experienced by patients living with diabetes has been identified as a common cause of 999 calls to South East Coast Ambulance Service NHS Foundation Trust (SECAmb) across Kent Surrey and Sussex, with the subject of many calls being the same patient. Following a 999 call where the hypo is resolved and conveyance to hospital is not required, patients were rarely followed up by community diabetes or primary care services as there was no process for notifying appropriate healthcare professionals about the episode of hypoglycaemia. The lack of follow up for patient means the opportunity for education and intervention to prevent further hypos is lost and puts the patient at risk of further hypos. This causes potential problems to patients’ quality of life and can cause avoidable 999 calls and hospital admissions.
The South East CVD SCN 2014 commissioning guidance suggests commissioners should aim to:' Reduce the frequency of hospital admissions for service users with diabetes, including episodes of diabetic ketoacidosis, severe hypoglycaemia and hyperosmolar non ketotic state by 20% in 3 years’ (p.9). Source
A recent observational study has also concluded that severe hypoglycaemia appears to be associated with increased mortality at 12 months, particularly in type 2 diabetes. Source
What we are doing
A pilot project commenced in 2014 and went live in January 2015 with two CCGs in Surrey (NHS North West Surrey CCG and NHS Surrey Downs CCG) in partnership with SECAmb and Merck Sharp & Dohme Limited (MSD). The project involves developing robust clinical management pathways between SECAmb and both primary care and community diabetes providers. The AHSN and South East Coast Strategic Clinical Network is now working in collaboration with SECAmb and MSD to complete the rollout of the Hypoglycaemia Care Pathway across the whole of the Kent Surrey and Sussex region.
We will also be providing training for SECAmb clinicians with the support of MSD, to improve knowledge about diabetes, the disease process and post-hypo aftercare. This will be rolled out across the region in the form of study days and eLearning resources.
To find out more about the Hypoglacaemia care pathway, click here
New blood glucose devices for SECAmb
South East Coast Ambulance Service NHS Foundation Trust is introducing a new blood glucose meter to ensure that patients’ blood glucose readings are as accurate as possible. Following work on the Hypoglycaemia Pathway with partners from primary care, the AHSN, SE SCN and MSD Pharmaceuticals, it was clear that the devices currently used by SECAmb could be improved upon in terms of the accuracy which can optimise the assessment of a patients glycaemic state – particularly in patients who may have suffered an asymptomatic hypoglycaemic episode.
The meters, supplied by Nova Biomedical, also include the ability to record ketones and these additional test strips will follow later this year. Importantly, when testing the blood other molecules which affect the accuracy of the reading in other machines are measured and their bias excluded. The new devices will be rolled out during February and March, and we hope that when feeding blood glucose readings back to GPs and DSNs, the results are able to be better relied upon due to the increased accuracy.