Shadowing a diabetes team in Wakefield – Emily Watts
As Clinical Champions Project Manager I work with health care professionals regularly. Promoting best practice is part of my job and I therefore I think it is vital I have a good understanding of what clinicians come up against in the ‘real world.’ This March, one of our Champions, Ryan D’Costa, who is a Diabetes Consultant at Pinderfields Hospital organised for me to shadow his diabetes team. During my two days of shadowing I came across a number of situations that showed me how complex diabetes care is. Here are some things I took away from my visit.
I arrived in Wakefield on Monday morning and met with some of the Diabetes Specialist Nurses (DSNs) who I would be working with. I watched them pull off the referrals that had come through from various hospital wards that had patients suffering from diabetes related problems. The first gentleman we went to visit had Type 2 diabetes and his sugar levels were recorded as being very high. We went in to his ward and the first thing I noticed was that the man had just had an amputation. I’ve been working at Diabetes UK for a year now and haven’t seen anyone with an amputation so was quite shocked and wondered if he had known this could happen. Our next patient was an older gentleman who was injecting the wrong doses of insulin. We sat and spoke to him for 20 minutes about his regime to work with him on how he might be able to manage his diabetes better to avoid future complications. Another thing that struck me from the wards was the number of people who were unclear whether they had Type 1 or 2 diabetes.
In the afternoon I got to shadow a clinic for ladies with gestational diabetes. The nurse took the ladies through what gestational diabetes was, how to check their blood sugar levels and the steps they could take to bring glucose levels down. It was interesting to see the nurse try and fit so much information in to a clinic – what gestational diabetes is, diet advice, stopping smoking, contraception etc. You forget that many people have co-morbidities and are trying to manage other conditions on top of their diabetes.
In the past few years primary care has been put under increasing pressure to manage complex patients with diabetes. With the number of people diagnosed with Type 2 soaring and with more people on the cusp of developing the condition you can imagine this is quite an undertaking. Wakefield has an innovative model where every GP practice has a consultant or DSN attached to it that visit to help them with their diabetes caseload. The number of visits they make depends on how competent the practice are at coping with diabetes based on a four level system. I was fortunate enough to spend the morning observing one of these ‘virtual clinics’ in Pontefract.
The GP started by working through a list of patients asking advice on what drugs should be prescribed and how to deal with certain issues. The rest of the morning was spent with patients with diabetes who benefitted from having a diabetes consultant in the room. This set up is clearly extremely beneficial to the GP who was able to tell patients he would ask a diabetes specialist questions such as ‘do I need to inform the DVLA I am taking insulin?’. (See Driving page of Diabetes UK website)
One thing I did take away from my visit is how dangerous ‘Dr Google’ can be. Diabetes UK has a big part to play in ‘busting myths’ and this Diabetes Week should be used to great effect.
MDT Foot clinic
My final visit was to an MDT foot clinic that included a diabetes consultant, vascular surgeon, diabetes specialist nurse and a podiatrist. This is a great clinic set up as all the people in the room had something valuable to contribute and could offer different levels of advice.
I feel very lucky that I was offered the chance to visit the diabetes team at Wakefield as all the staff were clearly committed to delivering the best care possible for their patients. My visit also confirmed to me that Diabetes UK shares an equal partnership with health care professionals who look to us for help and advice. Our offer of support is extremely beneficial and we need to work to ensure diabetes teams across the UK have access to the charities expertise.