Tool for the Assessment of Patient Education in Diabetes in Scotland ...

Assessment of PatientEducation in Diabetesin Scotland&Tool for the Assessmentof Patient Education inDiabetes in Scotland

ContentsAssessment of Patient Education in Diabetes in ScotlandIntroduction............................................................................................................... 1NICE criteria for structured education...................................................................... 2Philosophy............................................................................................................... 2Written curriculum.................................................................................................... 2Aims and Learning Outcomes.................................................................................. 3Trained Educator...................................................................................................... 3Quality Assurance.................................................................................................... 4Audit........................................................................................................................ 5Tool for the Assessment of Patient Education inDiabetes in ScotlandIntroduction............................................................................................................... 7Philosophy................................................................................................................. 7Curriculum, Aims and Learning Outcomes.............................................................. 7Trained Educator....................................................................................................... 7Quality Assurance..................................................................................................... 8Audit.......................................................................................................................... 8References.............................................................................................................. 10Appendix................................................................................................................. 11Acknowledgements................................................................................................ 12A P E D S T A P E D S© NHS Education for Scotland 2012. You can copy or reproduce the information in thisdocument for use within NHSScotland and for non‐commercial educational purposes.Use of this document for commercial purposes is permitted only with the writtenpermission of NES.

Assessment of PatientEducation in Diabetesin ScotlandASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND

IntroductionThe Scottish Diabetes Action Plan 1 endorsedthe recommendations of SIGN 116 2 regardingstructured patient education within Scotland.Structured education is central to diabetescare and to the self management of long termconditions. Moreover, people living with diabeteshave stated that structured education was themost valued type of education. It is the aim ofthe Scottish Diabetes Action Plan that peoplewith diabetes receive a structured educationprogramme that fulfils the nationally agreed criteriafrom the time of diagnosis with annual review andhave access to ongoing education resulting in anincrease in the percentage of people participatingin self management programmes that will berecorded on SCI-Diabetes and reported for theScottish Diabetes Survey.The definition of a structured patient educationprogramme according to NICE 3 is:“a planned and graded programmethat is comprehensive in scope,flexible in content, responsive to anindividual’s clinical and psychologicalneeds and adaptable to his or hereducational and cultural background.The aim of patient education is for people withdiabetes to improve their knowledge, skills andconfidence, enabling them to take increasingcontrol of their own condition and integrateeffective self-management into their daily lives.Moreover, NICE recommend that:“structured patient education ismade available to all people withdiabetes at the time of initialdiagnosis and then as requiredon an ongoing basis, based on aformal, regular assessment of need.””The current document aims to define the processadopted within Scotland to assess patienteducation provision according to the DiabetesAction Plan 1 thus ensuring that people withdiabetes, and/or their carers, receive a structurededucation programme that fulfils the nationallyagreed criteria. The document is written forprofessional health care workers delivering patienteducation. It is acknowledged that patientscan also deliver patient education and thefollowing criteria would also apply to patient ledstructured education.The criteria that define a structured educationprogramme are:1. A philosophy2. An evidence based curriculum3. Aims and learning outcomes4. Delivered by a trained educator5. Quality Assured6. AuditedEach Health Board should have a Managed ClinicalNetwork (MCN) responsible for diabetes care.Each MCN is charged with ensuring the provisionof a range of educational solutions that shouldinclude quality assured structured educationfor people with diabetes. Each MCN maintainsrecords of educational provision and reports theirprogress towards meeting this standard to theScottish Diabetes Group.1REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

NICE 3 criteria for structured education1. Philosophy2. Written curriculumThe structured education programme has aclearly stated philosophy that reflects the beliefs,attitudes and values of the people with diabetes forwhich the course is aimed, and the professionalsdelivering the course.In Scotland, a strong philosophy of selfmanagement and life long learning for peopleliving with a long term condition, like diabetes, isdeveloping 4 . Patient education should promoteperson centered care, self management and activebehaviour change.The philosophy of an education programme shouldbe developed in conjunction with the people forwhom the course is aimed and will adopt an equaland diverse approach that is appropriate to thepatient regardless of geographical location, age,gender, race, religion, creed, disability, social class,sexuality, culture and life circumstances.The philosophy should be type specific andappropriate for the age group and educationalabilities of the persons attending. Partners andcarers should be included in the education processwhere appropriate.To engage with patients in writing a philosophy,professionals are encouraged to hold focus groupsor directed discussions with patients and theircarers. Patients may even lead the development ofthe educational philosophy if asked so to do.Any diabetes education programme requires awritten curriculum encompassing:• the philosophy• evidence based course content• aims and learning outcomes• lesson plans for each session• intended participants• evidence of educational theory appropriateto the intended participants• evidence of learning activities appropriateto the intended participants• method of assessment• resources to deliver the courseIt is best practice to have one named person,an Educational Lead, who is overall responsiblefor the programme while working within a team.All educational resources should be kept up todate, collated and easily accessible by all membersof the educator team. The curriculum content isindicative rather than prescriptive and there shouldbe a system to offer follow up topics not coveredin the programme but requested by individuals,hence according to need. This may take the formof a signposting system to leaflets, resources,other educational sessions, other services orthe person may require one to one support for aparticular issue.NICE CRITERIA FOR STRUCTURED EDUCATION 2

3. Aims and learningoutcomesThe programme should have an overall aim andobjectives that are expanded and developedthrough each session for which further aimsand learning outcomes should be written. Thelevel of learning and intended outcomes shouldincorporate the learning needs of the participantsand should build on previous knowledge, skills andexperiences of the participants.4. Trained EducatorAll normal Human Resource issues apply aroundthe employment and deployment of staff. All staffhave a job description that meets the Knowledgeand Skills Framework. All staff have a ProfessionalDevelopment Plan through which their ownlearning and developmental needs are identifiedand the meeting of these facilitated. Records areretained by staff and line managers of these and, ifappropriate, Human Resources Departments.There are nationally agreed competencyframeworks for nurses, dietitians and podiatristsworking in diabetes care 5, 6, 7 . The ScottishDiabetes Education Advisory Group recommendsthat these documents are used for the appropriaterecruitment of staff. Prior to delivering any patienteducation, it is essential that the professionalmust have knowledge of diabetes, experienceof working with people with diabetes as well asmeeting the requirements of a trained educator.It is recommended that professionals are mentoredby a more experienced practitioner the first timethat they provide an educational programme.Where mentoring is not possible, professionals areencouraged to maintain a written reflective log ofeach session.The knowledge and skills of a trained educator aredetailed below:1. Write a philosophy of education2. Write aims and learning outcomes3. Identify training and educationalopportunities4. Identify patient and carers learning anddevelopment needs5. Develop an educational session thatengages and supports patients in theirlearning and development6. Deliver an educational session that engagesand supports patients in their learning anddevelopment – including presentation skills,facilitation of learning and development,questioning skills7. Prepare and use PowerPoint slides/slides/overhead/visual resources as part of aneducational session8. Teach a skill e.g. blood glucose monitoring9. Manage learning and development ingroups10. Evaluate the learning of patients after aneducational session11. Improve learning and developmentprovision12. Reflect on, develop and maintain own skillsand practice in learning and development.It is recommended that the Educational Lead, whohas overall responsibility for the programme, isable to demonstrate all the above knowledge andskills (1-12). Those who are involved in deliveringpatient education, but not necessarily involved in1-5 above, are required to demonstrate 6-12 aswell as their understanding and application of thephilosophy to their teaching and adapting theirown teaching styles to meet the philosophy. It isthe responsibility of the Educational Lead to ensurethat only people with the necessary knowledge andskills are involved in delivering patient education.3REVIEWERS’ HANDBOOK FOR ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND (APEDS)

It is acknowledged that professionals are requiredto have many skills in caring for people withdiabetes. The clinical and educational skillsrequired will vary according to the patient’sjourney and their stage on this journey utilizing theeducational framework of the short life workinggroup on type 1 diabetes 8 (Appendix 1).All staff who are involved in supporting people withdiabetes and also in delivering patient educationare encouraged to develop the following skillsusing their annual Performance and DevelopmentPlan as a tool towards acquiring them:• robust consultative communication skills• skills in promoting behaviour change• the ability to conduct peer review• facilitation skills• motivational interviewing• skills in promoting decision making• skills in promoting self care andmanagement5. Quality AssuranceThe purpose of quality assurance is to ensure thehighest standard of delivery for all educationalprogrammes to meet their intended audiencein relation to its philosophy, aims and learningoutcomes. Specific aspects of each educationalprogramme or session will be evaluated and thedetail is defined under the heading ‘Audit’.Ultimately it is the responsibility of each HealthBoard to ensure that patient care is qualityassured. The outcomes of quality assuringeducational programmes and educational sessionswill be reported to the relevant MCN who will reportto the Health Board and, on behalf of the HealthBoard, to the Scottish Diabetes Group. Actionplans will be derived as required.Specific clinical outcomes are currently recordedon SCI-Diabetes and the offer to attend aneducational course, participation or otherwisewill also be recorded. This data will be reportedannually in an anonymous manner through theNational Diabetes Survey 9 .Written records (paper or electronic) of all aspectsidentified for quality assurance purposes willnormally be retained according to the NHS Codeof Practice 10 .TRAINED EDUCATOR 4

6. AuditThe outcomes from an educational programmeshould be regularly audited. It is acknowledgedthat specific clinical parameters are capturedon SCI-Diabetes. It is our intention that patienteducation offered, attended and completed wouldalso be recorded on SCI-Diabetes. At this stage,it is acknowledged that data cannot normally becollected regularly for people who attend a ‘oneoff’ teaching session.It is recommended that the written curriculumis reviewed at a minimum of every secondyear for its reliability, validity, relevance andcomprehensiveness although it is expected to beresponsive to new research or innovations andadapted accordingly.Each MCN should retain information on thoseproviding patient education including: name, jobtitle, qualifications that meet the skills identified forthe role of a trained educator, date of peer reviewor when self reflection was undertaken.Patient education will be undertaken in a varietyof settings and through different media e.g. telemedicine.For each venue utilized, there should beprocedures for dealing with emergencies duringprogramme delivery where possible.For each educational programme that a patientattends, specific data should be collected that isexpanded in The Tool for Assessment of PatientEducation in Diabetes in Scotland (TAPEDS).5 TOOL FOR THE ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND

Tool for the Assessmentof Patient Education inDiabetes in ScotlandTOOL FOR THE ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND 6

IntroductionThe following checklist has been derived to assesspatient education as meeting the NICE criteria forstructured patient education.The criteria that define a structured educationprogramme are:1. A written philosophy2. An evidence based written curriculum3. Written aims and learning outcomes4. Delivered by a trained educator5. Quality Assured6. Audited.For each Programme submitted for reviewplease provide written evidence on thefollowing programme structure:• The name of the Programme• The name of the Educational Lead whois also responsible for updating thecurriculum.• If this is a national programme (e.g. DAFNE,DESMOND, X-PERT Diabetes) has it beenmodified in any way?If yes, detail the modifications:e.g. duration, timing, content, resources• The intended target patient group• How the learning needs of the target patientgroup were identified• Names of all people participating indelivering patient education: theirprofessional qualification and job title• Where all educational resources areretained and how accessible they are to allmembers of the health care team• Dates of the educational programme• Venue of the education: NHS site, privatesector, non-NHS, patient’s home, viatelemedicinePlease provide written evidence of thefollowing:Philosophy• The philosophy of the programme• How patients were involved in developingthe philosophy• How the philosophy is communicated toand understood by patients, professionalsreferring and educationalists delivering theprogramme• How the philosophy supports selfmanagementCurriculum, Aims and LearningOutcomes• The educational theory appropriate to theintended participants• The evidence based course content• Aims and learning outcomes for eachsession• Lesson plans for each session• The learning activities appropriate to theintended participants• The method of assessment of learning• The resources used to deliver the courseTrained Educator• How each professional involved indelivering the programme meets therequirements identified in the APEDSdocument.7 TOOL FOR THE ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND

• Details of additional skills of theprofessionals involved in delivering theprogramme (APEDS page 4).• Details of mentorship provided to peoplewho are involved for the first time• Records of any peer reviews, externalassessment or self reflection for allprofessionals involved in deliveringpatient education.Quality Assurance• Where and how written or electronicrecords are retained regarding patienteducation• Patient evaluation forms• Evidence of peer review or self reflection onability to teach others.AuditPatient aspectsHow are the views of the participantsacquired of the programme?What actions are taken as a consequenceof participants responses?Professional aspects• How each educator is evaluated by patients• How professionals are facilitated to peerreview each other• Evidence of self reflection by all staffinvolved in delivering the programme 11, 12 .Organisational aspects• Patient attendance rates at the educationalprogramme• Patient completion rates at the educationalprogramme• Any identified accessibility issues• Date of last review of the written curriculum• How quality of life is assessed:Is quality of life assessed with youngpeople? If so, please state in what way itis assessed.Action taken as a result of the outcomesof the quality of life assessmentWhat attempts are made to continuallyassess patients’ knowledge and skills, preand post education?How patient confidence to changebehaviour is assessedHow patient behaviour change isassessedHow self management by patients isassessedINTRODUCTION 8

9 TOOL FOR THE ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND

References1. Scottish Government (2010) DiabetesAction Plan 2010. The ScottishGovernment, Edinburgh2. SIGN (2010) SIGN 116: Management ofDiabetes. SIGN, Edinburghwww.sign.ac.uk3. NICE (2003) Guidance on the use of patienteducation models for diabetes. TechnologyAppraisal 60. NICE, London4. The Scottish Government, Long TermConditions Alliance Scotland (2008) GaunYersl! The Scottish Government, Edinburgh5. Trend UK (2011) An integrated careerand competency framework for diabetesnursing. 3rd edition SB Communications,Londonwww.trend-uk.org9. Scottish Diabetes Group (2010) ScottishDiabetes Survey. Scottish Government,Edinburghhttp://diabetesinscotland.org.uk/Publications.aspx10. Scottish Government (2010) ScottishGovernment Records Management: NHSCode of Practice (Scotland) Version 2.0March, Scottish Government, Edinburgh11. NHS Education for Scotland Flying Starthttp://www.flyingstart.scot.nhs.uk12. NHS Education for Scotland EffectivePractitionerhttp://www.effectivepractitioner.nes.scot.nhs.uk/learning-and-development/clinicalpractice.aspx6. Diabetes UK (2011) An integrated careerand competency framework for dietitiansand frontline staff. Diabetes UK, Londonhttp://www.dmeg.org.uk/Doccuments/Dietetic%20Competency%20Framework%202011.pdf7. TRIEPodD-UK (2012) Podiatry CompetencyFramework for Integrated Diabetic FootCare – A User’s Guide TRIEPodD-UK,London8. Bath L (2009) Short Life working group oftype 1 diabetes. Scottish Diabetes Group,Edinburghhttp://diabetesinscotland.org.uk/Publications/Final%20report%20of%20the%20Type%201%20Diabetes%20Short%20Life%20Working%20Group.pdfREFERENCES 10

AppendixDiabetes Care: Mapping the patient/professional journey with the differingroles of patients and professionals throughout the journeyTime lineProfessionalsEducationaltheorySkills requiredProfessional Knowledge andUnderstandingPatientsupportDiagnosisGP/ConsultantDSN/PNAndragogy/DictateClear communicatorFacilitatorListening skillsEmpathyExpert diabetes clinical knowledgeKnowledge of how to teachinformationKnowledge of how to teach a skillBehavioural changeLevel 1Core SkillsGP/ConsultantDSN/PNDietitianPodiatristAndragogy/DictateAbility to:impart knowledge;pace the giving of information;teach a skill;reassure.Expert diabetes clinical knowledgeKnowledge of how to teachinformationKnowledge of how to teach a skillBehavioural changePeer supportDiscuss changes to lifestylee.g. food, physical activity,smokingLevel 2Living withdiabetesContinualContactGP/ConsultantDSN/PNDietitianPodiatristPsychologist,SchoolsAndragogy/FacilitateAvailabilityDiscernmentListeningAbility to:Empower;Motivate;Encourage;Praise where there isevidence of self-managementMotivational interviewingPsychological assessmentPsychological impact (HADS,PIDPAD)CHO countingWeight management programmesSmoking cessation clinicsFacilitation skillsBehaviour changeCare planning around person’sgoals and problem solvingPeer supportLevel 3ManagingdiabetesTeamSelfmanagementresource/FacilitatorPhilosophy of careAims and learning outcomesNICE criteriaStructured patient educationPeer learningand emotionalsupportStructuredPatienteducationLevel 3ManagingdiabetesTeamSelf-Management/FacilitatorAvailabilityDiscernmentListeningStructured patient educationIntensive insulin therapyMotivational interviewingPeer supportOngoingstructurededucationAbility to:Empower;Motivate;Encourage;Praise where there isevidence of self-managementMotivational interviewingPsychological assessmentPromoting behavioural changeCounsellingEmpoweringSelf-managementLong term conditionsPeer review for othersQuality assuranceCHO and insulin dose adjustment11 TOOL FOR THE ASSESSMENT OF PATIENT EDUCATION IN DIABETES IN SCOTLAND

AcknowledgementsThis document was developed by a variety of people through consultations and workshops.Contributors were people with diabetes and professionals from all Health Boards, Educational Leadsin Diabetes, the Steering Group for the National Education Co-Ordinator and members of the ScottishDiabetes Education Advisory Group.APPENDIX 12

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