Paediatric diabetes operational 1745.pdf - East Cheshire NHS Trust

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Adherence to GuidelinesThe MDT looks to work within the framework of Local, National and International diabetesguidelines, including NICE, Every Young Person with Diabetes Matters, Diabetes NSF andISPAD consensus Guidelines.(http://www.ispad.org/FileCenter.html?CategoryID=5)(http://www.nice.org.uk/nicemedia/live/10944/29390/29390.pdf)These have been used to inform our local guidelines for the management of DKA, newpatients, hypoglycaemia and the care of young people undergoing surgery amongst others.Our local guidelines are used by the team for management of all aspects of diabetes care.The guidelines are currently available on the Trust intranet, stre@mline database andshared drive.The guidelines are widely available on trust computers in all areas of the hospital wherechildren and young people with diabetes may be seen. The guidelines are presented in aformat that allows printed copies to be made and kept in patient records during anyhospital admissions. The diabetes guidelines also provide advice to non‐members of theteam who may be contacted out of hours by children or their families. They include adviceon the management of illness and our sick day rules. This is to help on call teams giveappropriate advice at time when the MDT is unavailable such a weekends and at night.At junior doctor induction sessions access to these local guidelines are discussed so that allmedical staff is aware of their existence and how they can be accessed when required.Psychosocial AssessmentThe Service has recently adopted the Yorkshire and Humber Paediatric Diabetes NetworkWellbeing in Diabetes Questionnaire Tool to help the assessment of psychological need inchildren and young people with diabetes. Children identified as requiring psychologicalsupport are referred to the local CAMHS team. It is recognized that this is not an adequateservice. We hope with the introduction of the new tariff, psychology services will beimproved.EducationAt the time of diagnosis all new patients and their families will be seen by the coremembers of the MDT within 24 hours of admission unless this occurs at a weekend. It willbe the consultant’s responsibility to discuss the diagnosis with the young person and theirfamily, and to decide on an initial treatment plan. A structured education programme willbe started by the PDSN’s including the administration of insulin injections blood glucosetesting and blood glucose monitoring and the recognition and treatment of hypoglycaemia.The families will also be seen by our specialist dietician and the family will be given adviceabout basic dietary issues. The basis of carbohydrate counting will be discussed. Once theteam and the family are happy that these initial self‐management skills have been learntwe will aim to discharge the young person home.The PDSN’s and dietician will arrange follow up home visits over the next few weeks tosupport the family and to complete the structured education programme. Documentationof progress will be kept in the nursing record. These home visits will continue for as long asis judged necessary by the PDSN’s and the family.Written education material will be given to all families at the time of diagnosis and will bereferred to at future home and hospital visits. Families will also be given contact details forthe team at the time of discharge.Children’s Diabetes MDT Operational Policy May 23, 2012 16
Education will continue throughout the follow up process. This will often be patient led.The form of education offered will be tailored to the needs of each patient and couldinclude topics around specific issues such as travel or the management of illness.Educational opportunities may arise at outpatient attendances or during future home visits.It is important to the MDT that we try to update our advice from time to time as often asaspects of care are forgotten over time.The PDSN has an increasing role in providing support and education within schools. This isparticularly since widespread introduction of multiple daily injection regimes and pumptherapy.The dietician and PDSN run group carbohydrate counting courses for families.‘The goals for diabetes education’ are being introduced as a way of documenting youngpeople’s progress with education.FacilitiesChildren requiring admission to hospital will be admitted to children’s ward. The ward hasthe facilities to monitor patients fully and to provide an appropriate level of nursing care forchildren admitted in DKA. This could include 1:1 nursing if required. Resuscitationequipment is provided on both wards and there is a fully equipped stabilization unit on theWard for the management of critically ill children. There are currently no dedicated HDUbeds.Young people over the age of 16 years who have started the transition process will beadmitted to the adult unit via MAU. Responsibility for the care of the young person wouldbe by the adult diabetes team.There are ICU facilities at MDGH and young people over the age of 16 would be admitted tothe local ICU for the management of their diabetes if the clinical need arose. Youngerchildren who require intensive care would need to be discussed with NWTS who willfacilitate the transfer of critically ill children with diabetes should this be required as for allother children in need of specialist intensive care.Children’s Diabetes MDT Operational Policy May 23, 2012 17
Page 1 and 2: Paediatric and Adolescent Diabetes
Page 3: Table of contentsIntroduction……
Page 6 and 7: Purpose of the MDTThe aim of the MD
Page 8 and 9: and their carers.• Contributing t
Page 10 and 11: Membership Arrangements Members of
Page 12 and 13: The MDT MeetingsWeekly MeetingsWeek
Page 14 and 15: Patient InvolvementThere is an acti
Page 18 and 19: Equality Analysis (Impact assessmen
Page 20 and 21: From the evidence available does th
Page 22: 7. Any actions identified: Have you

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