Ways of working through the Covid-19 pandemic - Community Diabetes Service
In light of the Covid-19 pandemic, many different services in hospitals around the country have had to adapt and find different ways of working to care for patients.
In this blog post we hear from Grace Njoku about the experience of the Community Diabetes Service at Mile End Hospital. We also hear from Amy Shlomowitz about the experience of Covering type 1 patients at both Mile End/Royal London Hospital and St Bartholomew’s.
Grace is the Lead Diabetes Nurse for Community Diabetes and Amy is the Type 1 (& Insulin Pump) Diabetes Nurse Lead for Barts Health. They complement each other in their various services thereby ensuring high quality care for all the patients.
Grace Njoku - Community Diabetes
How big is your team?
It is a big team consisting of 7 Community Diabetes specialist Nurses (CDSN) Led by (Grace Njoku), 2 Link workers (Health Advocates) - supporting the CDSNs to run clinics in GP’s Practices, 3 Community Dieticians, 2 Lay Educators – teaching group education for patients with type 2 diabetes (both English and Bengali languages), 5 Administrative staff, 1 Consultant is in charge of Community Diabetes (Prof. Chowdhury) + 2 Consultants from hospital team who runs clinics at the Centre, as well as 1 Clinical Psychologist. Also, 1 Lead Nurse for Pump & Type 1, and 1 Pump Nurse + Pump Administrator, 1 Dietician, 1 Service manager + 1 Service Delivery Manager. In total: 30 staff.
How long have you been working for the Diabetes Care Centre?
I’ve been working here for 15 months.
How have your roles changed over the last few months?
Dramatically! We’ve been information sharing with the team through the daily briefing from the trust, and running more virtual clinics than face-to-face patient clinic appointments. We’ve all been working more remotely where necessary and relying more on technology for meetings.
What are some of the things you’ve implemented to continue to care for diabetes patients during the pandemic?
We’ve implemented a number of things! We’ve been running virtual clinics so patients can still be seen, sending out information to patients for safety netting, holding face-to-face patient contact for urgent insulin start at the Diabetes Care Centre, post risk assessing the patient. We’ve also been ensuring that patients are given our work mobiles for easier contact if they need.
How have diabetes patients been coping?
A majority are coping well due to high standard of care maintained by the team as a whole. I have noticed that most patients are adhering more to advice now than before the pandemic.
What has the response been by patients to the changes you’ve implemented?
There hasn’t been a major complaint at present, apart from 3 occasions where 3 patients complained that they were unable to get through to the phone. With this in mind, CDSNs have been giving patients their work mobiles.
What are some things that have worked well?
The virtual clinics have worked well, as well as face-to-face urgent clinics for patients that need insulin initiation. Glucometer teaching is another thing that’s had a positive impact, as well as support with other healthcare professionals. During this time, I’ve also seen better teamwork within the team and genuine care for one another (thinking about each member’s safety and wellbeing).
What are some things you’d like to improve on?
Better working relationship with district nursing teams to ensure equity in care for all housebound patients within Tower Hamlets.
Have there been any changes in practice that will influence care for years to come?
Yes – virtual clinics are the way forward! It helps to improve DNA rate, it saves cost in transportation for patients, and also increases productivity. This is because a clinician may use 3 hours to contact as many as 10 patients, whereas a clinician will use the same 3 hours to review 6 patients with face-to-face clinic appointments.
Any final thoughts?
Our team have shown resilience in the face of Covid-19 by ensuring that we maintain high standard of care for all our patients. I am immensely proud of our hard work and achievements and we will continue to strive for high quality care at all time!
Amy Shlomowitz – Type 1 Diabetes team
The Type 1 Diabetes team have been very busy manning a 9am to 5pm Monday to Friday HOTLINE to answer diabetes related queries and help alleviate worries of those with type 1 diabetes who usually attend the St Bartholomew’s and Mile End Hospital Diabetes clinics. This also meant for many type 1s who had their appointments re-scheduled due to Covid-19 that they could still obtain any advice they required. The questions raised included issues such as shielding, discussions with their employers regarding returning to work, high blood glucose and illness and pregnancy queries. We have maintained regular contact with our at risk patients, our young adults, and our pregnant ladies to ensure their safety.
Consultations have turned to virtual for most of our type 1 patients and we are looking at devising a questionnaire going forward to learn if some of our type 1s would like some of their future appointments to be virtual (through NHS Anytime Anywhere or telephone) as well as still attend their face to face appointments. A mixture may be appealing so they do not need to take too much time off work to attend appointments.
People with type 1 diabetes with out of warranty Insulin pumps have been upgraded with their new pumps virtually which have gone very smoothly and the pump users have been pleased that Covid-19 has not meant for them a delay in receiving their new pumps.
People with type 1 diabetes who were to attend training to be fitted with a glucose measuring device (called the Freestyle Libre) funded on the NHS were still able to gain access to this very important device. However, rather than attend face to face group appointments we sent them approved online training modules to complete. This also meant they were not delayed in gaining access to the system.
We are also extremely proud of our Senior Type 1 Diabetes CNS Vicky Reilly who was voluntarily re-deployed to ITU to help. We are grateful of her efforts!