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NiP Awards news - insulin initiation

The first ever NiP Annual Awards are approaching their conclusion. The standard was extremely high making it difficult for the judges, but after much debate the final nominees in each category have been chosen, and we will be highlighting these projects over the coming weeks in the run-up to the Awards ceremony taking place at the NiP Event in Birmingham on 19 November.

To start off we look at one project that managed to get shortlisted for the Diabetes Award.

Back in April 2005, any patients needing insulin conversion in West Norfolk were referred into secondary care, to DSNs or to Julie Widdowson, a diabetes educator/facilitator and practitioner. This meant that patients had to travel to unfamiliar surroundings, and meet with new professionals at what is a difficult and confusing time.

To make this process easier it was decided to educate practice nurses to initiate insulin in primary care.

The programme used was the "Intensive Management in Type 2 Diabetes", accredited by Warwick University and delivered by trained educators. To undertake this programme nurses have to be running diabetes clinics and have a diploma qualification in diabetes, and the support of the practice. The course runs for nine months and within this time the student has to have started at least six patients on insulin. A formal write-up of reflective practice is also submitted.

Norfolk Community Health Care now has 17 trained nurses who initiate insulin in 15 practices. In the last year only two patients have been referred to secondary care for insulin initiation.

Julie Widdowson explains: "This has enabled practice nurses to feel empowered to continue their patients' management, and support them to the next step in treatment. Equally patients can be started at an earlier point in their disease journey, when HbA1c levels are starting to decline."

Julie now runs update sessions every six months for the nurses and GPs who have qualified in insulin initiation. These sessions include new therapies, insulin devices, carbohydrate counting and case studies. It gives the chance for sharing of experience and support of practice.

he Nursing in Practice Awards 2008rewards best practice in a variety of clinical areas, and are designedto recognise excellence and innovation in the primary care setting.

The diabetes award is being sponsored by the Insulin Dependent Diabetes Trust

The Insulin Dependent Diabetes Trust (IDDT) is a registered charity and was formed in 1994. We are concerned with listening to the needs of people who live with diabetes, understanding those needs and doing our utmost to offer help and support.

Would you like to see a similar programme rolled out in your area? Or is there one already in place? Your comments: (Terms and conditions apply)

"I am a practice nurse in North Wales and we have been initiating insulin since 2005 with a very similar training programme. We have found that we get great support from the DNS, however, the GP treat us as DNSs and our specialism is not diabetics on insulin and all the problems that develope. Patients prefer to see us and we feel more empowered. We do not swap patients to QDS regimes, however, we may swap over to a BD regime from a daily long acting. You need very supportive GPs and time to keep in close contact with patients, and a good DNS team to seek further advice." - Diane Bartley, N Wales

"Yes, we have a similar course but not initiated properly as sometimes the resistance lies with the GP who has lot of work, thus not prepared to take on such a responsibility although nurses can start etc but do need GP support too. It is a very good idea as one gets started. It is not as hard as one thinks..." - Ying Metcalfe, Enfield