Reviewers' Handbook for Assessment of Patient Education in ...

Reviewers’ Handbook
for Assessment of Patient Education
in Diabetes in Scotland (APEDS)

Contents
Reviewers’ Handbook for Assessment of Patient Education in
Diabetes in Scotland (APEDS)
Introduction....................................................................................................................................... 1
Review Process ................................................................................................................................ 2
Terminology....................................................................................................................................... 3
General Aspects................................................................................................................................ 3
Philosophy......................................................................................................................................... 4
Curriculum, Aims and Learning Outcomes...................................................................................... 4
Trained Educator............................................................................................................................... 5
Quality Assurance............................................................................................................................. 6
Audit.................................................................................................................................................. 2
patient aspects.............................................................................................................................. 6
professional aspects...................................................................................................................... 7
organisational aspects................................................................................................................... 7
References........................................................................................................................................ 8
Appendix
1. SCI-Diabetes Descriptors of structured education.......................................................................... 9
2. Review of Structured Patient Education....................................................................................... 14
3. Reporting template for acceptable Programme............................................................................ 19
4. Reporting template for minor adjustments to the Programme...................................................... 20
5. Action plan template.................................................................................................................... 21
Acknowledgements: This document was developed by a variety of people through consultations and
workshops. Contributors were people with diabetes and professionals from all Health Boards, Educational
Leads in Diabetes, the Steering Group for the National Education Co-Ordinator and members of the
Scottish Diabetes Education Advisory Group.
© NHS Education for Scotland 2012. You can copy or reproduce the information in this
document for use within NHSScotland and for non‐commercial educational purposes.
Use of this document for commercial purposes is permitted only with the written
permission of NES.

Reviewer’s Handbook
This handbook must be read and utilized in
conjunction with the Assessment of Patient
Education in Diabetes in Scotland (APEDS)
and Tool for Assessment of Patient Education
in Diabetes in Scotland (TAPEDS) and the
descriptors for recording structured patient
education on SCI-Diabetes (Appendix 1).
The ethos for reviewing educational
programmes is of support and valuing quality.
It should be a constructive experience for both
reviewers and reviewees.
Introduction
The main outcome of reviewing structured patient
education is to record education received by each
person with diabetes on SCI-Diabetes and so lay
the foundation for quality assured, incremental
education being received by each individual living
with diabetes. A secondary outcome is to increase
the quantity and quality of education offered to
people living with diabetes throughout Scotland.
Reviewers have been nominated by the
Educational Leads in each Health Board
representing people with diabetes and
professionals from all disciplines involved in
diabetes care. Reviewers are considered by their
peers to meet the following criteria:
• actively involved in delivering patient
education to people with diabetes or a
person living with diabetes who is actively
involved in self-management and relates
well to others
• are trained educators or a person living with
diabetes who demonstrates the ability to
educate others – not necessarily in diabetes
• have capacity for undertaking reviews
• have a collegiate approach
• have a strategic approach to care
• command the respect and integrity of their
colleagues
• are willing to commit as a reviewer for a
minimum of 3 years
• are willing to undergo training to be a
reviewer
It is expected that the workload would be the
equivalent of 2 days for each programme being
reviewed. Reviews will be conducted electronically
with some telephone or email communications.
INTRODUCTION
1

Review Process for assessing structured patient
education programmes
1. Health Boards will be invited to submit their
Programme Documentation for assessment
to the Scottish Diabetes Education Advisory
Group. The TAPEDS will inform the material
to be submitted. Electronic submissions are
required.
2. Submitted Programme Documentation will
be sent to reviewers who will live or work in a
different Health Board than the Programme for
review.
3. There will normally be three reviewers for each
submitted programme and must include one
person with diabetes and one professional. The
third person may be another person living with
diabetes or another professional, preferably
from a different professional group than the first
one. One person will be identified as the Lead
Reviewer.
4. The Lead Reviewer is responsible for cocoordinating
the responses of the other
reviewers and communicating the outcome
to the Scottish Diabetes Education Advisory
Group. All reviewers are expected to fulfill this
role on a rotational basis.
5. The reviewers will individually review the
programme according to the TAPEDS template
(Appendix 2).
6. The reviewers will communicate with each
other with regard to their findings, identifying
any areas that need further exploration or
clarification.
8. After any further exploratory communications,
the reviewers will agree on the outcome.
9. The above process should be completed within
6 weeks of any Programme being submitted
for assessment.
10. The outcome may be:
a) The programme is acceptable for recording
on SCI-Diabetes (Appendix 3)
b) The programme is acceptable for recording
on SCI-Diabetes subject to minor
adjustments that must be undertaken
within 3 months (Appendix 4). At the end of
3 months, the Educational Lead will submit
amendments to the original reviewers who
will determine if the adjustments have been
made.
c) The programme is not yet acceptable for
recording on SCI-Diabetes. A detailed
action plan will be compiled (Appendix
5) and the submitting Educational Lead
asked to address it. The Educational Lead
will be given 6 months to re-submit the
Programme, with amendments, to the
original reviewers who will determine if the
adjustments have been made.
d) Records of Programmes acceptable for
recording on SCI-Diabetes will be retained
by the Scottish Diabetes Group.
7. The Lead Reviewer will communicate with
the Educational Lead for the Programme for
clarification of any identified area. This may be
by telephone, Skype, or independent visit. All
reviewers will be encouraged to participate in
these communications but the Lead Reviewer
is the only one required to participate.
2 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

Terminology
It is important that the same language is used when referring to submitted Programmes. For this purpose, a
list of the most common terminology used is presented. This is in sequential order.
Programme
This relates to an entire educational experience.
Normally education will be delivered over several
hours, days or weeks. Programme relates to all the
sessions delivered.
Some Programmes may be delivered over one
session e.g. Diabetes Footsteps developed under
the auspices of Fife Health Board. A one session
programme is still required to meet all the criteria of
a programme.
National Course
This relates to those courses that have been
developed under the auspices of research,
normally a randomized control trial. Examples are:
DAFNE, DESMOND, X-PERT Diabetes.
Session
This relates to one individual educational
experience. It may occur in a group setting or on a
one-to-one setting. It may be conducted face-toface,
over the telephone or other media.
Ongoing education
This relates to level 2 education 1 . As such, it
normally relates to one individual educational
session. However, any level 2 education submitted
for review must meet the criteria of a programme.
Indicative content
This is a list of topics that will be addressed.
The indicative content may refer to the whole
programme or may refer to one teaching session.
A national course is not required to be reviewed
using the APEDS and TAPEDS so long as it is
being reviewed by its authorizing body and it has
not been modified in any way.
General Aspects
Reviewers are asked to read the following pages
in tandem with Appendix 2 and the submitted
Programme for review. Each reviewer should
complete Appendix 2 independently from other
reviewers and using the Programme information
submitted. The boxes will expand to accept written
text. There are a few key components to note.
If this is a national course that has been modified, it
is important that such modifications are noted, for
example, the duration of the programme, its timing,
the content or any different resources utilized.
There are a variety of ways in which people’s
learning needs are identified. If a person has
been just diagnosed with diabetes, there is
clearly a self-management need. If however a
person has ongoing problems with, for example,
hypoglycaemia, their learning need may be
identified by a clinical requirement. Very few
Programmes formally assess people’s learning
needs and hence this may not be explicit in
Programme documentation.
TERMINOLOGY
3

Philosophy
The philosophy of the Programme may be
presented as a mission statement, a philosophy
or as an overall ethos. The philosophy should
be communicated to participants, professionals
referring participants to the Programme and to
those participating in delivering the Programme.
Hence, there should be evidence of the philosophy
on all communications with others.
It is good practice to involve people with diabetes
in the development of the philosophy however, if
the Programme is well established, this level of
detail may not be obvious.
Curriculum, Aims and Learning Outcomes
The educational theory should support active
learning by the participants. It may employ adult
learning theory or child specific learning theories.
Any educational programme will have a
Programme Aim that is normally one sentence
indicating the overall purpose of the Programme.
Thereafter, the Programme normally has about 4-6
learning outcomes. These learning outcomes are
high level and will be achieved by attendance at
the individual sessions within the Programme. The
number of individual sessions will vary according to
each Programme timetable.
Each individual session will have an aim and
normally about 3-4 learning outcomes. The
individual sessions will also have indicative content
which is the list of actual topics or aspects to be
covered within each session. Lesson plans indicate
the methodology used to exchange knowledge,
skills and attitudes. It may be highly structured,
for example see the Diabetes Education Network
website (http://diabetes-education.net/index.
phplink=curriculum)
findings should be obvious in educational
programmes although reviewers need to be
cautious about the time when a Programme
is submitted for review and the timing of new
research being available. One example might be
the withdrawal of an oral hypoglycaemic drug in
one month and yet the Programme mentions the
drug because the Programme was delivered six
months previously.
The focus of the aims and learning outcomes is
to identify learning around aspects of knowledge,
skills and attitudes. Kirkpatrick 2 has developed a
framework for evaluation that identifies four levels.
Kirkpatrick’s framework is a simple and pragmatic
model that is widely used. The levels and means of
assessment are identified in the table overleaf.
or it may be totally participant led, for example,
Conversation Maps TM . If there is no structured
lesson plan, indicative content ensures that the
topics are addressed.
All education should reflect the knowledge of
current research and hence the Programme
content should be evidence based. New research
4 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

Table: Adapted from Kirkpatrick 2 to meet diabetes education
Level Meaning Assessment
1 Initial reaction to the learning
programme
2 The resulting increase in
knowledge or capability
before and/or after education
3 This involves applying the
new knowledge to the
persons’ life style that
may include behaviour
change
4 This involves the major
impact of the learning on the
person’s life style that may
impact on others beyond the
individual him/herself.
Normally assessed by reaction questionnaires; post-it notes;
Normally use before and after knowledge questionnaires.
May include self assessment of knowledge. May include
observation of skill rehearsal e.g. blood glucose monitoring
Immediate assessment is more difficult as there is a time
element necessary for the person to make changes and for
others to see the changes. Observation is a key assessment
tool. Participants may be encouraged to maintain a diary,
reflective log, or develop an action plan.
Immediate assessment is more difficult as again, there is a
time element necessary for the person to make changes
and for others to see the changes. The major impact may be
assessed through observation, assessment of attitudes and
behaviours that promote self care management. Assessment
would normally look at both hard data e.g. HbA1c as well as
soft data e.g. patient satisfaction
Most education programmes delivered will be
assessing Levels 1 and 2 only. It is impractical for
programmes to assess at Levels 3 and 4 unless
there is some long term follow up built into the
programme. SCI-Diabetes will eventually be able to
give some Level 4 data but this will not be available
for some time yet.
Assessment of learning therefore relates to
what has been taught. While knowledge can
be tested using questionnaires for example, it
will probably only test recent, rote learning and
will not necessarily test recall of knowledge or
the application of knowledge to an individual’s
lifestyle. Learning may be evident by, for example,
the development of a positive attitude towards
regularly attending clinics where previously the
person did not attend.
A skill may be assessed by observing the person
undertaking the skill for themselves. Coupled
with all this, there may be literacy, numeracy and
language issues that prohibit the use of a written
assessment. Reviewers are required to accept the
creativity demonstrated through different forms of
assessment of learning that has occurred.
Resources relate to physical resources e.g.
physical space, ability to photocopy handouts,
simulated materials and to human resources e.g.
other professionals or people with diabetes that are
able to contribute to the Programme.
Trained Educator
The APEDS identifies the knowledge, skills and
attitudes required of a trained educator. Each
person identified as involved in the delivery of
education is required to provide evidence of how
they meet these. The Educational Lead is required
to meet all aspects. Those who are not Educational
Leads are required to evidence only the last six
aspects (APEDS & TAPEDS page 3).
Participants are encouraged to submit any other
CURRICULUM, AIMS AND LEARNING OUTCOMES
5

evidence of peer reviews, external assessment or
self reflection.
Quality Assurance
The purpose of quality assurance is to determine
that the best possible educational opportunities
are offered to people with diabetes. In itself, it is a
process of which the whole APEDS is part.
For the submitted Programmes, quality assurance
relates to where and how written or electronic
records are retained regarding:
• patient education;
• any evidence of patient evaluation forms
of the Programme;
• any peer review or self reflection on the
ability of the educational providers to
teach others.
Audit
This area is divided into three sections: patient,
professional and organizational aspects.
Patient aspects
There are a variety of tools used to assess
quality of life. Some Programmes use nationally
recognised questionnaires e.g. Hospital Anxiety
and Depression Scale (HADS), or the Problem
Areas In Diabetes (PAID). Others might use
questioning as a way of assessment.
If the Programme is directed at people below the
age of 18 years, there might not be any formal
assessment method used. There is a lack of valid
and reliable tools to assess quality of life with
young people. If the Programme, for people below
the age of 18 years, attempts to assess quality of
life, please record what is used for this purpose.
Some Programmes may assess quality of life in an
anonymous manner and so no individual action
can be taken. Some will assess quality of life before
the Programme and then at a time period after the
Programme has been completed. At this stage, it
is important to capture what is being done as there
are no particular recommendations being made.
Any attempts to assess people with diabetes’
knowledge and skills, pre and post education are
to be recorded. In some ways, this is a continual
process which will be evident through how
individuals engage verbally with the health care
team and how their behaviours relate to what has
been taught. There can be literacy problems that
prohibit the use of questionnaires and this may
be assessed normally through verbal questioning.
Reviewers are encouraged to recognize the
expertise of the health care team in assessing
individual’s knowledge and skills.
While it is recognized that education is one tool
necessary for learning and implementing into
practice, it is only the individual living with diabetes
who can actually implement learning into behaviour
change. All Programmes are encouraged to
promote behaviour change towards self care
management and one element within this is an
individual’s confidence to make those changes.
Therefore, confidence to make changes should be
assessed.
Coupled with this, the Programme should
provide evidence about how behaviour change
is actually assessed. Using Kilpatrick’s model
above, it may be that this form of assessment is
more longitudinal and is undertaken by observing
behaviours rather than attempting to measure the
intention to behave in certain ways.
Self-management of people with diabetes is crucial
for long term health benefits. The Programme
should provide evidence of how this is assessed.
This may be through reflecting on a situation or
the development of an action plan arising from a
clinical situation. There will be variety in how this is
done and reviewers are encouraged to embrace
variations in this element.
The views of people attending educational
Programmes or sessions are crucial. Programmes
should present different ways in which participants
views are determined.
6 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

This may be by a questionnaire, verbal questioning,
or informally through word of mouth. Normally,
people will respond if they have benefitted from the
education but may be reluctant to give feedback
when it is their own health care professionals
who are delivering the education. Reviewers
need to be cautious in their own interpretations of
Programme reviews.
The Educational Lead for the Programme
thereafter needs to demonstrate what actions have
been taken as a consequence of participants’
responses. Examples may be a:
• brief written statement of intent to alter who
contributes to a Programme;
• statement about changing a venue to make
it more accessible to others;
• statement about changing the method of
educational delivery.
Professional aspects
Programmes are required to demonstrate how
those who contribute to it are evaluated by
participants. This element may be integrated into
the audit section above and reviewers may need to
scrutinize evaluation forms etc. before they find the
relevant evidence.
Programme providers are encouraged to peer
review each other although this is not always
practical. Peer review, including undertaking it and
giving constructive feedback is a skill that health
care professionals are encouraged to learn.
reflect on their practice but not all will maintain
a written record of this. Written reflections
may use a template, derived from two national
professional development Programmes 3, 4 or it
may take the form of a diary or similar account. As
these reflections are personal to the health care
professional, individuals will not be asked to submit
the actual account but rather state if they have
undertaken reflection or not.
Organisational aspects
In submitting Programmes for review, the
Educational Leads are expected to submit the
numbers of people who attended the Programme
and the completion rates.
Any accessibility issues should be identified. These
may include physical aspects e.g. the computer
for presenting material did not work; literacy issues
e.g. the Programme was prepared for adults
who could speak English but there were a higher
proportion of people attended for whom English
was not their first language.
The curriculum of educational Programmes should
be reviewed every second year as a minimum. The
date of the last review of the curriculum should be
recorded and noted.
Programmes are required to meet 80% of the
criteria to be acknowledged as meeting the
requirements for recording on SCI-Diabetes. The
essential criteria are identified with an asterisk *.
Where professionals undertake peer review of
each other, there may not be the requirement for
them to also undertake personal reflection on
their teaching. Reflection is part of the feedback
integrated into peer review. Therefore, this part
of the process could be an either/or scenario as
opposed to ‘both’.
All health care professionals are encouraged to
AUDIT 7

References
1. Bath L (2009) Short Life working group of type 1 diabetes.
Scottish Diabetes Group, Edinburgh
http://diabetesinscotland.org.uk/Publications/Final%20report%20of%20the%20Type%20
1%20Diabetes%20Short%20Life%20Working%20Group.pdf
2. Tamkin P, Yarnall J, Kerrin M (2002) Kirkpatrick and Beyond: A review of models of training
evaluation. The Institute of Employment Studies, Brighton
3. NHS Education for Scotland Flying Start
http://www.flyingstart.scot.nhs.uk
4. NHS Education for Scotland Effective Practitioner
http://www.effectivepractitioner.nes.scot.nhs.uk/learning-and-development/
clinical-practice.aspx
8 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

Appendix 1
SCI-Diabetes Descriptors for recording patient education
These descriptors have been agreed by the Scottish Diabetes Education Advisory Group for recording
patient education onto SCI-Diabetes.
Type 1: Level 1
Type 1: Level 2
The patient, at diagnosis, participates in an
education programme provided by a suitable
qualified health professional that addresses the
core skills required to survive and to begin making
life style changes to live with diabetes. The patient
education delivered meets the NICE criteria.
Core skills identified are:
• Insulin: its action, how to administer, store;
• How to self monitor blood glucose
• The place of ketones
• Basics of diet
• Cause, diagnosis, treatment and prevention
of hypoglycaemia
• Cause, diagnosis, treatment and prevention
of diabetic ketoacidosis including the sick
day rules
• Assessment of smoking status
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
The patient participates in an ongoing education
programme provided by suitably qualified health
professionals that addresses the needs of the
individual to make life style changes and supports
self management in living with diabetes. The
patient education delivered meets the NICE criteria.
Examples of curriculum content:
• Carbohydrate counting
• More in-depth hypoglycaemia
• More in-depth hyperglycaemia
• Exercise
• Insulin dose adjustment
• School/College/University/Employment
issues
• Driving
• Alcohol
• Insurances
• Foot health education
• Benefits of clinic attendance
• Eye screening
• How to avoid diabetes complications
• Travel and holidays
• Sexual health
• Psychological issues
APPENDIX 1
9

Type 1: Level 3
Type 2: Level 2
The patient participates in an education
programme provided by suitably qualified
health professionals that is part of a programme
addressing specific aspects of self management
that will support the patient making life style
changes to live with diabetes. Level 3 programmes
are recognized as structured patient education
programmes and meet the NICE criteria. Examples
of such programmes are DAFNE and Intensive
Insulin Therapy.
Type 2: Level 1
The patient, at diagnosis, participates in an
education programme provided by a suitably
qualified health professional that addresses
the core skills required to begin making life
style changes to live with diabetes. The patient
education delivered meets the NICE criteria.
Core skills identified are:
• Basics of diet
• Anticipated future treatment options
• Oral hypoglycaemic agents: when to take,
expected side effects, what to do if unwell
• Planned monitoring
• Assessment of smoking status
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
The patient participates in an ongoing education
programme provided by suitably qualified health
professionals that addresses the needs of the
individual to make life style changes to live with
diabetes. The patient education delivered meets
the NICE criteria.
Examples of curriculum content:
• Carbohydrate counting
• More hypoglycaemia dependent on oral
hypoglycaemic agent
• Exercise
• Employment issues
• Driving
• Alcohol
• Insurances
• Foot health education
• Benefits of clinic attendance
• Eye screening
• How to avoid diabetes complications
• Travel and holidays
• Sexual health
• Psychological issues
Type 2: Level 3
The patient participates in an education
programme provided by suitably qualified
health professionals that is part of a programme
addressing specific aspects of management that
will support the patient making life style changes to
live with diabetes. The patient education delivered
meets the NICE criteria. Level 3 programmes
are recognized as structured patient education
programmes. Examples of such programmes are
DESMOND, Weight reduction programmes, Long
term conditions self- management programmes.
10 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

Gestational Diabetes: Level 1
The patient, at diagnosis, participates in an
education programme provided by suitably
qualified health professionals that addresses
the core knowledge and skills for diabetes
management during pregnancy and the postpartum
period. The patient education delivered
meets the NICE criteria.
Core skills identified are:
• How to self monitor blood glucose
• Basics of diet
• Assessment of smoking status
• NHS/DUK help lines
• Identification e.g. card or bracelet
They may also include:
• Insulin: its action, how to administer, store;
• The place of ketones
• Oral hypoglycaemic agents: when to take,
expected side effects, what to do if unwell
• Cause, diagnosis, treatment and prevention
of hypoglycaemia
• Cause, diagnosis, treatment and prevention
of diabetic ketoacidosis including the sick
day rules
• Social Security benefits
Maturity Onset Diabetes of Youth:
Level 1
• Oral hypoglycaemic agents: when to take,
expected side effects, what to do if unwell
• Planned monitoring
• Assessment of smoking status
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
Latent Autoimmune Diabetes of
Adulthood: Level 1
The patient, at diagnosis, participates in an
education programme provided by a suitable
qualified health professional that addresses the
core skills required to survive and to begin making
life style changes to live with diabetes. The patient
education delivered meets the NICE criteria.
Core skills identified are:
• Insulin: its action, how to administer, store;
• How to self monitor blood glucose
• The place of ketones
• Basics of diet
• Cause, diagnosis, treatment and prevention
of hypoglycaemia
• Cause, diagnosis, treatment and prevention
of diabetic ketoacidosis including the sick
day rules
• Assessment of smoking status
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
The patient, at diagnosis, participates in an
education programme provided by suitably
qualified health professionals that addresses
the core skills required to begin making life
style changes to live with diabetes. The patient
education delivered meets the NICE criteria.
Core skills identified are:
• Basics of diet
• Anticipated future treatment options
Maternally Inherited Diabetes and
Deafness: Level 1
The patient, at diagnosis, participates in an
education programme provided by suitably
qualified health professionals that addresses
the core skills required to begin making life
style changes to live with diabetes. The patient
education delivered meets the NICE criteria.
APPENDIX 1 11

Core skills identified are:
• Basics of diet
• Anticipated future treatment options
• Oral hypoglycaemic agents: when to take,
expected side effects, what to do if unwell
• Planned monitoring
• Assessment of smoking status
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
Neonatal Diabetes (Permanent):
Level 1
The neonate’s parents/carers participate, at
diagnosis, in an education programme provided
by a suitable qualified health professional that
addresses the core skills required to survive to
live with diabetes. The patient education delivered
meets the NICE criteria.
Core skills identified are:
• Insulin: its action, how to administer, store;
• How to self monitor blood glucose
• The place of ketones
• Basics of diet
• Cause, diagnosis, treatment and prevention
of hypoglycaemia
• Cause, diagnosis, treatment and prevention
of diabetic ketoacidosis including the sick
day rules
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
Pancreatic Pathology: Level 1
The patient, at diagnosis, participates in an
education programme provided by a suitable
qualified health professional that addresses the
core skills required to survive and to begin making
life style changes to live with diabetes. The patient
education delivered meets the NICE criteria.
Core skills identified are:
• Insulin: its action, how to administer, store;
• How to self monitor blood glucose
• The place of ketones
• Basics of diet
• Cause, diagnosis, treatment and prevention
of hypoglycaemia
• Cause, diagnosis, treatment and prevention
of diabetic ketoacidosis including the sick
day rules
• Assessment of smoking status
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
Secondary - Drug Induced: Level 1
The patient, at diagnosis, participates in an
education programme provided by a suitable
qualified health professional that addresses the
core skills required to survive and to begin making
life style changes to live with diabetes. The patient
education delivered meets the NICE criteria.
Core skills identified are:
• Insulin: its action, how to administer, store;
• How to self monitor blood glucose
• The place of ketones
• Basics of diet
• Cause, diagnosis, treatment and prevention
of hypoglycaemia
12 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

• Cause, diagnosis, treatment and prevention
of diabetic ketoacidosis including the sick
day rules
• Assessment of smoking status
• Role of drugs including alcohol
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
Secondary – Disease: Level 1
The patient, at diagnosis, participates in an
education programme provided by a suitable
qualified health professional that addresses the
core skills required to survive and to begin making
life style changes to live with diabetes. The patient
education delivered meets the NICE criteria.
Core skills identified are:
• Insulin: its action, how to administer, store;
• How to self monitor blood glucose
• The place of ketones
• Basics of diet
• Cause, diagnosis, treatment and prevention
of hypoglycaemia
• Cause, diagnosis, treatment and prevention
of diabetic ketoacidosis including the sick
day rules
• Assessment of smoking status
• Role of drugs including alcohol
• NHS/DUK help lines
• Social Security benefits
• Identification e.g. card or bracelet
APPENDIX 1 13

Appendix 2
Review of Structured Patient Education in Diabetes in Scotland
General Aspects
Health Board
Date received
Date reviewed
Date submitted comments to relevant person
Name of Programme*
Name of Educational Lead *
National Course with
modifications
Yes
No
Details of
modifications*
Intended patient group*
How identify learning
needs *
Self-referral
Referred by
professional/other
Other means:
(please list)
Programme participants
names submitted*
Where educational
resources retained*
Accessibility of educational
resources*
Dates of delivered
programme *
Professional
qualification
Yes
Yes
No
Job title Yes No
No
Comment
Comment
Venue* NHS site Private sector Telemedicine
Patient’s home
Other
(please list)
14 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

Philosophy of the programme
Philosophy present* Yes No
Were people with
diabetes involved in
its development
Yes
No
If yes: how
If no, why not
Does it support self
management *
How is it shared
Yes
No
Curriculum
Educational theory*
Evidence based
course content*
Aims and outcomes
for each session*
Lesson plan for each
session
Appropriate learning
activities *
Assessment of
learning*
Yes No
Yes No
Yes No
Yes No
Verbal Written Demonstration
Other
(please list)
Resources used*
APPENDIX 2
15

Trained Educator: to be completed for each person teaching on the programme
Writing a philosophy
Writing aims and learning
outcomes
Identify training and educational
opportunities
Identify patient and carers learning
and development needs
Develop educational session
Deliver educational session*
Prepare and use visual aids*
Teach a skill*
Manage group education*
Evaluate learning*
Improve learning and
development provision*
Develop own learning abilities*
Evidence of additional skills
Is mentorship required Yes No
If yes, what is the
evidence *
Any further evidence
16 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

Quality Assurance
How are records retained of
patient education *
Written Electronic Both
Where are records retained of
patient education *
Have any patient evaluation forms
been submitted
Yes
No
If Yes: what is
overall summary *
What evidence has been
submitted on peer review/
evaluations to teach others *
What is the summary of peer
review etc *
Audit: Patient aspects
Is quality of life assessed Yes No
What action is taken after QoL
assessment *
What attempts made to continually
assess patients’ knowledge and
skills per and post
If yes: how*
Is confidence to change behaviour
assessed
Yes
No
If Yes: how *
Is behaviour change assessed Yes No
If Yes, how *
Is self management assessed Yes No
How are participants views of the
programme captured *
What actions are taken in light of
the reviews *
If Yes, how *
APPENDIX 2 17

Audit: Professional aspects
How are educators evaluated by
participants *
Is peer review undertaken Yes No
If Yes,
How*
If No,
why not
Is there evidence of self reflection * Yes No
If Yes,
How*
If No,
why not
Audit: Organisational aspects
Number of people invited to attend*
Number who attended at the start*
Number who completed*
Any accessibility issues identified Yes No
If yes, what
were they
Date of last review of curriculum and is
this within the last 2 years *
Date:
Yes
No
18 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

Appendix 3
Reporting template for acceptable Programmes
Please submit this form to the Scottish Diabetes Education Advisory Group
Health Board
Name of Programme
Name of Educational Lead
Name of Lead Reviewer
Profession/Person
with Diabetes
Date of report
I am writing to inform the Scottish Diabetes Education Advisory Group that the above Programme has been
reviewed and has been deemed to meet the requirements of structured patient education.
This is appropriate for people with (NAME type of diabetes from SCI-Diabetes list) and at level (NAME level
from SCI-Diabetes list).
Name of 2 nd Reviewer
Profession/Person
with Diabetes
Name of 3 rd Reviewer
Profession/Person
with Diabetes
APPENDIX 3 19

Appendix 4
Reporting template for minor adjustments to the Programme
Please submit this form to the Scottish Diabetes Education Advisory Group
Health Board
Name of Programme
Name of Educational Lead
Name of Lead Reviewer
Profession/Person
with Diabetes
Date of report
I am writing to inform the Scottish Diabetes Education Advisory Group that the above Programme has been
reviewed and the Educational Lead is to be asked to make minor amendments to the Programme and to
resubmit it for further review before it is deemed to meet the requirements of structured patient education.
Aspect
Minor adjustment
Philosophy
Curriculum
Trained Educator
Quality Assurance
Audit
Name of 2 nd Reviewer
Profession/Person
with Diabetes
Name of 3 rd Reviewer
Profession/Person
with Diabetes
20 REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

Appendix 5
Action plan template
Please submit this form to the Scottish Diabetes Education Advisory Group
Health Board
Name of Programme
Name of Educational Lead
Name of Lead Reviewer
Profession/Person
with Diabetes
Date of report
I am writing to inform the Scottish Diabetes Education Advisory Group that the above Programme has been
reviewed and the Educational Lead is asked to compile an action plan to amend the Programme and to
resubmit it for further review before it is deemed to meet the requirements of structured patient education.
Aspect
Philosophy
Curriculum
Trained Educator
Quality Assurance
Audit
Key issues to be addressed
Action plan to be completed by
Educational Lead
Name of 2 nd Reviewer
Profession/Person
with Diabetes
Name of 3 rd Reviewer
Profession/Person
with Diabetes
APPENDIX 4/5 21

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Published September 2012
NHS Education for Scotland
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