Having reassurance and advice from a health professional can make a big difference during pregnancy, especially if you are a mum-to-be with type 1, 2 or gestational diabetes.
Which is why, thanks to some small changes behind the scenes of three antenatal diabetes clinics, specialist diabetes nurses are seeing pregnant patients as soon as possible, providing support when it is needed most and helping to make pregnancy a happy time.
Mum-of-two Rachel D’Arcy, from Ashford, who has twice had gestational diabetes, explained how seeing a specialist from Kent Community Health NHS Foundation Trust (KCHFT) helped her, when she was pregnant with her second son.
She said: “Emma, who I saw at the clinic and who phoned me between appointments, was so supportive. When I had pregnancy cravings, but was trying to eat the right things, she kept telling me how well I was doing. She’d say, I know it’s tough, but you are doing fantastic, which really helped.
“I appreciated how we had conversations about things, rather than her telling me that I needed to do things. She would say this is what we recommend and we would have a chat about it. She was fantastic.”
KCHFT specialist nurses are seeing more mums-to-be at the clinics thanks to working closer with East Kent Hospitals University NHS Foundation Trust (EKHUFT). EKHUFT run the clinics, at the William Harvey Hospital in Ashford, the Kent and Canterbury and the Queen Elizabeth The Queen Mother at Margate and KCHFT nurses and admin staff support them.
Previously, KCHFT specialist diabetes nurses were arriving at the clinic and had to start the day by loading patient details onto the trust’s electronic patient record system, Rio. Because this took up time, it reduced the number of people they could see.
But thanks to work led by Susan Parsons, Clinical Lead in the KCHFT Diabetes Service, a new way of working has been established, which sees the admin teams at both trusts collaborating, so patient details are uploaded by admin colleagues beforehand. This has resulted in each clinician saving 45 minutes per clinic and as a result, an extra patient slot has been added to each of the three clinics, each week. Margaret Levison, KCHFT Operational Lead with the Diabetes Service, has been involved in implementing the extra appointment.
Susan said: “Nurses were having to come to clinic early to process the referrals onto Rio. We realised we needed to get our admin team and the EKHUFT admin team working together, to get access to clinic lists beforehand and to get admin processes in place before clinic day.
“For clinicians to arrive at clinic and everything is ready to go is fantastic and colleagues have said this has reduced stress.
“We did this as a quality improvement (QI) project, using QI methodology to help us to streamline the admin process. One of the QI advisors, Robyn, guided me as to how QI could be used, as I’d not used the tools before. We used a driver diagram and a plan, do, study, act (PDSA) approach. We started the new process at one clinic, to see how it would work and then rolled it out to the others.”
Another driver behind the improvement was the increased demand for the service and a need to generate more capacity to see patients. Since the pandemic, the KCHFT Diabetes Service has seen a large increase in demand for the clinics. Susan put this down to improved screening, women choosing to have children at an older age and an increase in people being overweight.
The changes have also made a difference to KCHFT colleagues.
Emma Andrews, Diabetes Specialist Nurse, said: “As a clinician I am now able to arrive at clinic, set up, have a very quick multi-disciplinary team meeting and get on with seeing patients, rather than have to put patient details into Rio and other admin jobs. It’s an absolute game-changer.
“Things are so much better now as I feel there is more cohesion with EKHUFT colleagues. The time saved improves communication, discussion surrounding concerns with patients, referrals required and individualised management plans. It’s been a fantastic piece of work for all involved.
“Since this has changed, I am able to offer a face-to-face assessment in the afternoon, which has reduced the number of people on the waiting list.”
