November 2017 Innovating for Improvement · Final report November 2017 Innovating for Improvement...

Final report

November 2017

Innovating for Improvement

Integrated structured education programme for paediatric newly

diagnosed type 1 patients to empower them in self management

(DEAPP)

University Hospitals of Leicester and the Children and Young People with Diabetes East Midlands

Network.

About the project

Project title:

Integrated structured education programme for Paediatric newly diagnosed type 1

diabetes patients to empower them in self-management (DEAPP)

Lead organisation:

University Hospitals of Leicester NHS Trust.

Partner organisation(s):

The Children and Young People’s East Midlands Diabetes Network (CYPEMDN).

The Design Unit, School of Design, De Montfort University

Chesterfield Royal Hospital NHS Trust

Derby Hospital NHS Trust

Nottingham University Hospitals NHS Trust

Sherwood Forest Hospitals NHS Trust

Project lead(s):

Dr James Greening, Clinical Lead and Mrs Marie Atkins, Project Manager.

Contents

About the project ............................................................................................................... 2

Part 1: Abstract .................................................................................................................. 3

Part 2: Progress and outcomes ......................................................................................... 3

Part 3: Cost impact .......................................................................................................... 11

Part 4: Learning from your project ................................................................................... 13

Part 5: Sustainability and spread ..................................................................................... 16

Appendix 1: Resources and appendices .......................................................................... 18

Part 1: Abstract

Our project delivered the full diabetes curriculum for children and young people

newly diagnosed with Type 1 Diabetes using a “flipped” learning approach and an

app (Deapp – Diabetes education app). There are over 26,000 children in England

and Wales with Type 1 Diabetes: 3000 are based in the East Midlands region, our

setting for piloting this innovative approach to promote self-management in Type 1

Diabetes.

Flipped learning involves the patient learning the theory via a virtual learning

environment, combining visual, auditory, kinaesthetic and emotional learning and

that knowledge is then tested via face to face learning.

We originally wanted to design a website that was a moodle based platform of

learning. However following initial discussions around the practicalities of this and its

design, it would have looked very unappealing for children to use. We decided to

design an app with high-quality animation and face to face resources to run

alongside because it is more visual for children and is better suited to how children

already learn and engage, whilst making it fun and interactive, yet still giving them

the knowledge that they need to learn about diabetes.

Our innovation has already been embedded amongst 4 of the teams across the East

Midlands diabetes network. We were ambitious in our original plan of piloting this

across 5 sites in the East Midlands. Feedback from staff has been positive and

indicates that this innovative approach is effective and takes less time to deliver than

the previous model.

Part 2: Progress and outcomes

It was originally intended that the educational content for Deapp would be stored on

and delivered through a virtual learning environment (VLE) such as Moodle.

However, despite the structural and graphical flexibility within Moodle, it did not offer

the standard needed for Deapp. We found it was:

• Simply not ‘fun and engaging enough for the range of ages (particularly the

younger ones) that would be using it.

• Better suited to older students in higher education groups.

• Needed to be more visually interesting.

Developing a dedicated app had a number of potential advantages over a VLE such

as Moodle:

• Greater freedom to organise and present content in a way that was

appropriate for younger users.

• A higher professional standard of the animation.

• Made it easier to navigate whilst building in visual interest.

Below is what the app looks like on the ipads at the beginning and each line shows

the progression until all 12 learning modules have been completed.

This shows one of the sessions that the children undertake. As they watch the

videos they then get a tick to show it has been completed. We also have online

games developed into the app. For example, video 7 is a game where you guess if

the food has carbohydrates or not.

The key to this project is being able to assess a patient’s knowledge and below is a

picture which is the backend of the app which is what the HCP’s see when assessing

a patient’s knowledge.

We have produced visuals of all 12 sessions and these are included in the

appendices. The 12 modules are:

• What is diabetes?

• Practical Skills

• Food

• Highs and lows

• During illness

• DKA (Diabetic Keto-Acidosis)

• Correction doses

• Carbohydrate counting

• School

• Exercise

• Future complications

• Travel and lifestyle

With a project of this size involving multi organisations there were many things that

went less smoothly than we would have liked, these include:

• The amount of time and resources required to complete the project was

underestimated without a full-time dedicated Project Manager.

• The issues concerning the use of the app in hospital environments regarding

wifi networks/ security within each individual trust despite seeking assurances

and by supplying them with Ipads. This proved more time consuming than

anticipated.

• Trying to work with patients who did not have access to IT or did not have

phones that were compatible.

• Dealing with a national cyber attack right in the middle of producing the app.

• Agreement and finalisation of the teaching materials with a medical team of

20 HCPs across 5 pilot sites.

Challenge of delivering training (we have included the agenda in the appendices) to

each of the 5 pilot sites, comprising 50 HCPs. This training was essential in

delivering this flipped learning model to patients. This proved to be invaluable as this

quote explains:

“Training facilitators were fantastic really engaged the group and the understanding

and knowledge of the project, it moved at a fast pace but not too fast, very interactive

and hands on, plenty of opportunity for discussion, contribution. Good explanation of

flipped learning and app. Excellent teaching linking to theory and practice, Very well

prepared and delivered, activities kept participants engaged. Excellent day thank you

(one of the most useful study days I have attended),

We have qualitative data from staff indicating that this model reduces their workload,

and we will be gathering statistical data to confirm this. Below is another quote.

“I feel that patients get a better experience at diagnosis having gone through the app

and being assessed on their knowledge reinforces the information given and also

gives the PDSN a better understanding of how well the family have understood and

retained the information. The resources used to assess knowledge have helped to

focus and have helped to engage them regardless of age. Having the app also

enables the family to go back and recap on knowledge as they need”. Following the

introduction of the app with patients we designed an evaluation form for parents and

patients to complete after they were diagnosed and before they left the hospital. We

had already involved children and parents in the development of this app and they

had trialled the modules for us and gave feedback on information before it went live.

Below is one of the stand-out quotes from one of the parents.

“It was very useful to be left alone with the app/or to watch it with XX. It gave me

chance to listen to it at my own pace, to look at sections again if I wanted to. It was

also useful at raising questions for me to ask the team when I wasn’t always sure

what questions to ask!”

This was our originally evaluation plan.

We set up a database recording all activity and a summary is below (also refer to

appendices):

• 54 patients diagnosed out of our predicted numbers of 100 patients.

• 7 of these 54 patients have completely finished using the app

• 20 patients were not able to partake in the app due to various issues including

IT issues and for some of these English being their first language.

• Nottingham had 21 patients that were unable to partake in the project due to

problems with IT.

In regards to the statistics from the app usage we can see that:

• Number of patients: 485, of which 366 have never completed a step

• Active patients: 119. (Some will be tests – it is not easy to pick them out)

• Number of self registrations: 54 (again some are tests)

• Non patients (hospital admins etc): 54

• Number of steps completed: 2,562

• Sessions completed: 614

In terms of app installs, according to the stores:

• Android = 37

• iOS = 87

We have completed statistical analysis on the patient’s quality of life and knowledge

via a survey monkey, 11 patients have completed the survey which is lower than we

wanted despite various ways of trying to engage them to complete this. The analysis

looks at 3 areas: (We have been able to use Nottingham patients as a surrogate

control as they have not yet started using DEAPP and have continued education in

the standard manner).

• A Kauffman Competency and measure of diabetes self – management, it is

based on a numerical scale from 1-8.

• A measure of hypoglycaemia awareness via the Clarke score. Any score >4

defines hypoglycaemia unawareness and indirect maker of poor control.

• The PAID (problem areas in diabetes) and psychological assessment of

diabetes wellbeing.

Measure Site Average Range

Kauffman competency

Other 4 pilot sites 4.1 range 2-6

Nottingham 4 range 3-5

Paid “problem areas in diabetes”

Other 4 pilot sites 10.29 range 5-14

Nottingham 10 range 7-13

hypo scores

Other 4 pilot sites <4 range 0-3

Nottingham <4 range 0-2

The primary conclusion from this limited data is that there appears to be no

difference in outcome between the 2 groups. However 11 patients aren’t enough for

a reliable analysis. We will continue data collection beyond the project term to allow

our statistician to do more robust analysis that we will share with others and we

intend to apply for an RCT to provide the evidence to an academic standard.

We also took a baseline analysis of HbA1c at 3 and 6 months. It is medically proven

the lower the HbA1c and the longer the numbers remain low, the risk of further

complications are reduced. We are still aiming to complete the 9 and 12 months

analysis.

Interpretation: although number are small at this stage DeAPP demonstrated at least parity

with traditional education.(By default 1 centre Nottingham wasn’t able to enrol patient so has

worked as a de-facto control group)

HbA1c outcomes measures (mmol/mmol)

Centre At Diagnosis 3 months 6 months

Leicester (n=29) 93.5 61.75 52

Derby (n=7) 100 62.5 N/A

Chesterfield (n=14) 107.76 51.13 45

Sherwood forest

(n=10)

113.77 52.33 N/A

Average (n= 60) 101 55.31 50.61

Queen Medical

Centre

(control n= 21)

103.61 50.42 46.52

Below is a summary of just one of the pilot sites data (the full data report is included

in the appendices).

Trust

Username

Used by Patient or Staff?

Date of Diagnosis

Age of Child

Progress as of 24/08/17


HbA1c at diagnosis mmol/mol

HbA1c at 3 months mmol/mol


Sherwood PZ180-002 staff N/A N/A N/A N/A N/A N/A N/A

Sherwood PZ180-003 staff N/A N/A N/A N/A N/A N/A N/A

Sherwood

PZ180-004

patient

22/04/2017

16

During Illness

No further progress

113

33

Sherwood

PZ180-005

patient

28/04/2017

15

During Illness

No further progress

92

83

Sherwood

PZ180-006

patient

01/05/2017

12

During Illness

No further progress

cant find

52

Sherwood

PZ180-007

patient

08/06/2017

15

During Illness

No further progress

131

37

Sherwood

PZ180-008

carer/patient

09/06/2017

5

During Illness

No further progress

101

DNA clinic

Sherwood

PZ180-009

carer/patient

20/06/2017

5

During Illness

No further progress

88

45

Sherwood

PZ180-010

patient

01/06/2017

11

What is Diabetes and Food Completed only

Completed all of it

136

64

Sherwood PZ180-011 patient/carer 21/08/2017 8 During Illness Exercise 103 awaiting

Sherwood PZ180-012 patient/carer 20/09/2017 6 During illness 141 awaiting

Sherwood

PZ180-013

patient/carer

13/10/2017

10

Completed all of it

119

awaiting

Part 3: Cost impact

Original Budget : £75,000 (awarded by the Health Foundation) Additional Funding: £75,000 (matched by Sanofi Aventis - Medical Education Grant) Total Budget : £150,000 Total Spent: £133,374.00 Remaining budget: £16,626.00

Researched Costs

Actual Costs

Organisation Reasoning

£25,000

£0

£0

£30,000

£0

£0

£900.00

£120,000 (inc Vat)

£3094.85

£765.00

£0

£2987.90

£3782.00

£0

De Montfort Uni

External Professional Facilitators

Video/Photography (BCH)

N/A

IT Dept (BCH)

Kegworth House

N/A

Due to designing an app rather than a website, which was a free platform. This also included the cost of the resources at a higher standard, due to the prototypes.

We decided to provide a structured training programme, for the staff, over 3 days.

This was agreed, to act a training tool, when we decide to roll out to other units and also to act as a refresher.

Project Manager/Project Coordinator, we realised that we needed this money, at the beginning to pay for the app services with DMU

2 IPads for each trust were purchased to ensure that the pilot teams were able to deliver the education.

We agreed to hold weekly meetings, at a mutually convenient for all 5 sites. (originally we planned to meet at the Hospital sites, however the time taken to travel would have been significant)

Each team decided not to claim for travel, to help save costs.

The initial quote for DMU to design everything for just the first five sessions

including all of the games and resources was £50,000 excluding VAT. This was over

and above any estimate that we had costed for. Due to us being awarded the grant

from the Health Foundation back in August 2016 and this being a staged payment

system, it became apparent that we really needed additional funding.

Once we secured the additional funding this was fantastic as it meant that we could

finish all 12 sessions of the app. However these obviously had to be paid for and

again we paid DMU another £50,000 excluding VAT. In total out of the £150,000

awarded we have paid DMU (£120,000 including VAT).

In total out of the £150,000 we have been awarded we have spent, £133,374.00. We

have kept aside £6000.00 of the remaining £16,626 budget from Sanofi, (we have

already used all of the money from the Health Foundation) for the statistics and

paying Leicester University for this service. We also wish to buy Ipads and supply

the games and resources for the additional 6 hospitals in the East Midlands Network

which will use up the rest of the £10,000 money for this project. The app has been

built to be future proofed so that changes can be made more easily, however this

will inevitably cost money along with the training of staff etc. If another unit agrees to

adopt Deapp we are going to be incorporating running costs into this cost.

Part 4: Learning from your project

As our project focus changed dramatically at a very early stage of the project by

developing an app and resources rather than a moodle based platform, the project

team had to radically adapt our way of working. In hindsight what we wanted to

achieve with the app was extremely difficult to achieve within the timeframes

especially when we realised that 1 minute’s worth of animation takes a day to draw.

It is down to the dedication of the whole project group that we have been successful

in delivering this project. We have proved that this app works and although we don’t

yet have the detailed statistics to back this up, the initial findings are very

encouraging.

Early on in the project, once we decided to go with an app, we decided that we

would not compromise on the quality of this although it meant our timeframes were

very tight. We are all ecstatic with the finished project and so pleased that we did not

compromise on this aspect of the project.

One of the main challenges was getting a group of healthcare professionals to all

agree (this is something that is not uncommon in any project) and although the

project manager was used to dealing with differing opinions, it required negotiation to

ensure that everybody was happy in the project group and that the information was

clinically correct and the quality did not suffer.

We established weekly meetings for the group to try and ensure that everyone was

happy. This meant that everybody had a voice and felt included which was an

essential learning tool as geographically the teams are spread across the East

Midlands. By ensuring there were weekly, face to face meetings meant things were

not lost in communication.

All of the partners in this project bought into it from the outset 3 years ago and have

all worked hard to get this up and running. The entire project group gave up their

time including weekends and evenings to attend meetings, work on materials and

Marie and Sarah did 12-16 hour days regularly to keep the project to schedule. We

also had parents and patients on board. Technology was the biggest hindrance to

the success of this project.

Also, we had issues with culture due to some patients not being able to understand

sufficient English to engage in the project. Going forward, one of our aims is to

provide this education in different languages.

Whilst we did envisage issues with IT, we seriously underestimated the problem of

trying to engage five different IT trusts using different IT systems. Unfortunately

during this project the NHS was hit by a cyber bug which then made any progress

even more frustrating and long winded. The NHS could be regarded as its own worst

enemy; by trying to protect itself, it makes it impossible to make progress quickly on

new initiatives. Another example of a problem that we did not envisage was that

some patients originally from overseas having moved to the UK, may have

technology that is not compatible with accepting apps and digital information. This

meant that they were unable to participate. Some families also did not have

technology at home to participate.

Through the project it became obvious that our innovation was working effectively

and was fulfilling the brief of helping to identify gaps in patients’ knowledge before

they are discharged from hospital. All of the staff are delighted with this as it

highlighted where they need to spend additional time with patients. For example, one

pilot site had 4 newly diagnosed patients in one week and the app meant that the

team were able to manage their inpatient education workload which previously would

have proved very difficult.

As anticipated we have had to support members of the clinical teams with the

process of change whilst the app was being developed. The initial feedback from

children and their families has been lovely to receive because they love it, which we

hoped for, but is nice to actually know they appreciate it and want to use it and learn.

It also goes to show there was obviously an actual need for this which means that

we have been successful with our innovative ideas and approaches to educating

patients.

Our recommendations for the future projects are to double or even triple whatever

time frame you think you will need, especially if you are working with other

organisations. If you were completing this project in just one trust it would be

achievable, however once you bring in additional trusts and outside organisations

your time frames extend because you are relying on others to achieve things.

In hindsight and moving forward, we will be budgeting for the continuation and

further education sessions a lot better. We now have a greater understanding of how

much things cost and also how much time is involved to enable us to not make the

same mistakes next time.

Due to the nature of the project changing in its primary structure, this changed the

timeframes and the workload. When it was a moodle based resource this would have

been achievable in the timeframes that we stated however once it changed and with

everyone already working full time in their own jobs this was a major factor as we

had to rely on people’s goodwill and desire to finish this project and be successful.

Going forward, we have already started to make changes and will be more realistic

with our own times frames and those of others.

We are planning to roll this project out nationally and will be getting each team to

liaise with their own IT departments before they sign up to the project to avoid issues

that we have had so it does not delay them. Any future teams also need to buy in to

the whole package. It’s not just about the videos and animations, it is about the

flipped learning and teaching patients in a completely different way which is actually

easy. Because patients don’t know any different, it’s about changing the mind-set

and practices of all the HCPs

The flipped learning part of the innovation has proved to work. We now need to

collect data to prove this. This had been our intention, but due to the late completion

of the app (version 6 of the app was launched in August 2017) we have not been

able to achieve this. However, we will be obtaining this pilot data for at least 6

months, and would be happy to produce further report for the Health Foundation on

the findings.

Part 5: Sustainability and spread

Our project is definitely going to be carried on past this report. We have planned the

following:

• January 2018 – Apply for additional funding from the Health Foundation with

their programme.

• Re-launch of the project in February 2018 to the original 5 pilot sites.

• March 2018 – launch the project to the remaining 6 hospitals in the East

Midlands.

• March 2018 – Do a full media launch.

• March 2018 – Complete a statistical analysis to show findings and if

appropriate look into avenues for a RCT.

• April 2018 – Develop a pump section to the app (dependent on if funding is

successful). We have already had interest from relevant industry with regard

to supporting this.

• June 2018 – Present this to the National Network for adoption and approval

from them.

• Summer 2018 – Apply for a Quality in Care Award.

• Autumn 2018 – Apply for abstracts to be submitted to the following

conferences:

• Diabetes UK Conference,

• International Society of Paediatrics and Adolescents (ISPAD),

• British Society of Paediatrics and Endocrinology (BSPED).

• Advanced Technologies and Treatments for Diabetes (ATTD)

• Royal College of Paediatrics and Child Health (RCPCH)

• Association of Children’s Diabetes Clinicians (ACDC)

Type 1 Diabetes nationally have a network that is made up of 11 regions across

England and Wales and we already have a structure in place to share and

disseminate information. The initial feedback that we have had from regional

networks has been very positive. With 176 centres across England and Wales this is

immense and fantastic. There is also no reason why this project can not be rolled out

across adults with Type 1 and actually any English speaking country as information

about type 1 diabetes is the same regardless of age. We have also had interest from

adult services.

We have purposely not done any publications or applied for any awards relating to

this project as it was a pilot and we were trying to limit the people using the app to

only newly diagnosed patients across the 5 pilot sites to ensure validity of data and

statistics. Going forwards we plan to promote the app very strongly and apply for

awards. We are in the process of developing a marketing strategy and have

identified key conferences and national meetings to present at as listed above. We

also have identified peer reviewed journals to publish. Again we would be happy to

write a further report based on all of these outcomes.

This project could be adopted by any healthcare provider. The principles of this

project could be replicated across any disease. The flipped learning can be applied

to any healthcare condition: the resources and videos would have to be adapted.

Appendix 1: Resources and appendices

Appendix 1: Training Day Agenda for HCP’s

DEAPp Training day 28th February 2017/1st March 2017/2nd March 2017

Course aim and objectives for the day:

• To familiarise the pilot teams with the DEAPp project, video materials and

curriculum booklet.

• Establish the ethos of a flipped learning approach.

• Emphasise the need for flexible and varied assessment types and tools

• Develop confident questioning for use in practice, and as a resource bank for

all teams.

HCP’s were taught on the following:

• Theory of flipped learning

• The first 5 sessions of the project.

• Why is the assessor role so important?

• Different ways to assess patients knowledge

• How to make questions to assess knowledge

• Functions of the app and how to use it practically

• Discussion around not all patients are the same how to facilitate differences?

Appendix 2: Evaluation comments from the training days for HCPS

Bespoke One Day Training Course for DEAPp Healthcare Professionals

Diabetes Online Education Application:

Date of training. Red is Tuesday 10 forms Blue Wed x 19 12 x

Thursday

Training Evaluation

Course aims for the day:

• To familiarise the pilot teams with the DEAPp video materials and curriculum

booklet.

• Establish the ethos of a flipped learning approach.

• To emphasise the need for flexible and varied assessment types and tools.

• To develop confident questioning for use in own practice, and as a resource

bank for all teams.

1. Please tick the appropriate box: Strongly

Agree

Agree

Neutral

Disagree Strongly

Disagree

The aims of the course were largely achieved 5, 7, 9 5,

12,3

The course has up skilled my approach to assessing

and to becoming a more effective educator

5, 7, 8

4, 12,4 1

The course: 6, 11, 7 4, 8, 5

• Was relevant to my area of teaching

practice

6, 8, 7 4, 10, 1, 1

• Has raised my awareness on how to assess

children and young people of varying ages • Has helped me to link the theory of good

4

6, 5, 6 4, 14,

teaching and assessment practice to improving the delivery of health education

6

via the online DEAPp materials

2. The major strengths of the day were:

Great interactive session, group work, well thought course (x2), like whole idea, pace and

variety to see and experiment with, working with different people throughout day, skilled

facilitators and educators (x2), my understanding was good, resources very good, variety of

practical sessions covering a range of influencing educational factors such as age of child

topic covered and educational level, food section, putting ideas into practice, ideas on

alternative ways to teach (to be an educator!), fast pace, relevant, I really learnt a lot,

thanks so so much/actually inspiring/looking forward to using the app to help our CYP and

families. Utilising resources and looking at ways to assess learning, opportunity to give

feedback.

Time to critique the videos, meeting new people, good venue, good underpinning of

educational theory, learning how to educate using Blooms taxonomy and pedagogical learning,

quality of teachers, a good explanation of this new way of educating, and really getting me

to think more about assessing rather than teaching, a chance to look at the resources (x5),

getting view videos and familiarise resources, thinking about each can be used, moving around

short burst which helped to keep attention throughout, good to view the app. Good mixture

of taught stuff, viewing videos and group activities, Liked the way we looked at different

age groups, very informative and interactive sessions, course delivery and great interactive

and practical session, delivery of the session was very informal which encouraged

involvement, learned about flipped learning, availability of resources for DEAPp, good

educators and enthusiasm for deapp, facilitators, structure, venue, clearer picture on how to

use deapp and how to use resources, good link between watching clips and assessing

knowledge, assessment information, HCP settings in App itself. Learning how to assess CYP

etc, video app flipped learning understood the concept, interactive and enthusiastic team,

Training facilitators were fantastic really engaged the group and the understanding and

knowledge of the project, it moved at a fast pace but not too fast, good interactive sessions

(x3), a chance to experience all aspects of the app, very interactive and hands on , very

visual, plenty of opportunity for discussion (x2) and to contribute, facilitators very receptive

to contributions and valuing, Good explanation of flipped learning and app, sessions done at

varying times, Excellent teaching linking to theory and practice, good structure to the day,

Very well prepared and delivered, activities kept participants engaged. Excellent day thank

you (one of the most useful study days I have attended), good balance between theory and

practical sessions, opportunity to view app and provide feedback, videos very

useful/resources realistic, Good venue, variety of presentations and activities, safe

environment, friendly, very well organised course

3. The course would have been improved if…

Need more tips on non-verbal questioning, techniques to approach mute

teenagers/disinterested group, really young group visual aids and adjuncts, information given

as to how to role out APP and outcomes and info given to families, not such a tight time

limit, small room (x2), look at more at start so familiar with layout, read up on course

before hand, prevue videos and course content, run through contents of the box with list of

contents in box.

Preferred theory of teaching AM. And app info PM (I found it a bit distracting flicking from

one to the other), written info on using the app. Shorter day, more ipad to share with the

group when sharing the use of the app, we had a short session at the beginning to look

through resources box (x2), tables to work around, more space for work shops, more of an

introduction to the resources, the start date of the 13th is too soon,

Nothing to improve (x2), could have had agenda before, more time to use the ipad for those

who are not well versed with technology given the short time the pilot starts, pre-course

info, maybe in videos “3D” structure to explain cell and key model (insulin),

4. Aspect of the course Excellent Good Satisfactory Poor Unacceptable

Delivery of material… 6, 14, 10 4, 5, 2

The learning activities…. 6, 6, 9 4, 13, 3

The management of activities… 6, 13, 8 4, 6, 4

My learning achievement… 5, 6, 7 5, 13, 5

Content of course… 7, 11, 9 3, 8, 2 (1

missing)

Accommodation… 1, 13, 8 2, 6 (Chilly

x1), 3

(chilly x1)

3 4xn/a

N/A x1

Catering…. 2, 14, 10 4, 5, 2 1

Overall the course was… 6, 12, 9 4, 7, 2 (1

missing)

5. Course

organisation/content

Was there sufficient pre course information and instructions? Yes 11, 5/No 7, 6

If no what else would have been useful?

Did not receive any (x2), would have like pre-course reading as I am a slow learner, I did not

attend network so only knew date and time, more about pilot aims and objectives, outcome

measures and study design,

Would be good to send out more info before training day (x2), course outline not clear, more

access to app. It was difficult to supply more info than you did, unaware of course info except

direction, time and venue, some info on days structure would have been helpful,

Aims/objectives of the day/plan for day as only had venue info pre course

Brief presentation of the curriculum of deapp, could include list of resources, came with open

mind, enjoyed thoroughly, did not have precourse instructions (x2), curriculum could be given out

before hand so know what to expect during the day, timetable for day,

Is 1 day the right length? Yes 10, 18, 11 /No

If no please give suggestions.

Could be shorter finish at 4pm, a lot but not sure 2 days needed

Can be made shorter, could have been a half day perhaps,

Good structure with plenty of breaks to keep hydrated

Is the course information and teaching practice something you would use again back in your work

place?

Yes 10 19, 12/No

Please comment

Learn very useful approaches to teaching patients, transferable and adaptable, absolutely I am

keen to do new reading/practice on being an educator, I have found this session really useful and

interesting and it will definitely shape my future practice.

As a team we need to look at the materials and decide how we can use it for patients and carers,

assessment of understanding, tip to defer question from patients until relevant, rather than

feeling forced as they are raised, yes definitely!! It has given me ideas and made me think about

new ways of approaching education to the benefit of the patients, I have a bit more info to

underpin the project, good to have refresher on teaching skills, motivating to revamp my teaching

style, especially how to flip learn

Absolutely really helpful information, excited to start using it, It was really useful to have some

training on how to train/deliver the education, I have been able to think about my practice and

have ideas on how to improve my standard of education delivery, learnt “use different styles of

questioning” for various age groups, It made me reflect on my approach in consultation/teaching

not only in diabetes but in other areas of my practice too, Yes I feel this will enhance my practice

and am looking forward to outing it into use,

Are you interested in becoming more involved with the development of further online DEAPp

materials and supporting curriculum documentation? Yes /No

Do not work enough hours to develop deapp

If so, please give your name here Zainab, Nicki (but not tues), Marion, Rachel swindle, Julie Smith

Pooja, Aan mayes, Anne Rogers, Amy Ball, Rachel Williams, sarah Hodgkinson, Data manager

(?Nicki), Dawn Kitchen only if for ages 16-19years, Vaya Tziaferi, Prem Sundoram, sonal Kapoor,

Emma Green Marianne W, Rachel Cummings Sue Roach

Please add any comments to develop/support the answers you have given

Excellent boxed resources of good quality, thank you, I am keen that the food and CHO counting

session is current and evidence based so important to have latest info/would like to discuss

(Marion) thank you soo much, Sorry did not add positive comments

Enthusiastic facilitators, better understanding of an educator, resources will have to be looked at

not entirely accurate, excellent looking forward to putting into practice!! Thank you! Anne and

Julie were excellent facilitators thank you, just need more time/practice using /navigating the

ipad for app as not computer savvy

Excellent day and has made me realise what a lot of work it has been.

Maybe add a section where staff put comments on sessions or assessments on the app (but would

not be accessed by patients as password protected), really good bad feel as a professional, as we

get used to the app, it is going to be great especially as technology is the way forward this can

only equip us, over all a good day, I can see everyone has worked very hard on this project and this

is something that will enhance my practice and the app and prop box has been on my wish list for a

while thank you. Having training today has been helpful to deliver this education effectively –

thank you. Fantastic resources too, handouts of learning of theory - probing questions. Thanks to

all the facilitators it was a very useful introduction to deapp.

Thank you

Appendix 3: Evaluation form that parents fill in

1, On a scale of 0-5, Overall how useful did you find using the App?

0 1 2 3 4 5 (0=Not at all,5= Very useful)

2, On a scale of 0-5, Did you find the App easy to use?


3, On a scale of 0-5, How likely are you to use the App once discharged home?

0 1 2 3 4 5 (0=Not likely,5= Very likely)

4, On a scale of 0-5, How would you rate the contents of the videos


5, How did you feel about being given the App and using it without a member of the team

being present?

6, would you change anything about the App?

Appendix 4: Progress data of patients

Trust

Username

Used by Patient or Staff?

Date of Diagnosis

Age of Child



HbA1c at diagnosis mmol/mol



Chesterfield

PZ064- 001

Staff

N/A

N/A

School

N/A

N/A

N/A

N/A

Chesterfield

PZ064- 002

Staff

N/A

N/A

During Illness

N/A

N/A

N/A

N/A

Chesterfield

PZ064- 003

patient

20/03/2017

9

Highs and Lows

No further progress

132

42

48

Chesterfield

PZ064- 004

patient

19/04/2017

11

Highs and Lows

No further progress

142

51

42

Chesterfield

PZ064- 005

patient

26/04/2017

16

During Illness

No further progress

68

60

N/A

Chesterfield

PZ064- 006

patient

06/06/2017

14

Food

No further progress

125

46

N/A

Chesterfield

PZ064- 007

patient

09/06/2017

15

Not used

173

54

N/A

Chesterfield

PZ064- 008

patient

16/06/2017

13

During Illness

No further progress

102

58

N/A

Chesterfield

PZ064- 009

patient

31/06/2017

9

Practical Skills

No further progress

77

54

N/A

Chesterfield

PZ064- 010

patient

07/08/2017

11

Completed all of it

149

44

N/A

Chesterfield

PZ064- 011

patient

30/08/2017

3

Practical Skills

70

N/A

N/A

Chesterfield

PZ064- 012

patient

12/09/2017

1

What is diabetes

66

N/A

N/A

Chesterfield

PZ064- 013

patient

15/09/2017

9

During illness

97

N/A

N/A

Chesterfield PZ064- patient 07/11/2017 6 Practical Skills 83 N/A N/A

014

Chesterfield

PZ064- 015

patient

16/11/2017

10

N/A

N/A

117

N/A

N/A

Derby

PZ005- 001

Staff

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Derby

PZ005- 002

Staff

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Derby

PZ005- 003

Patient but moved areas straight after diagnosis

N/A

N/A

What is Diabetes

No further progress

N/A

N/A

N/A

Derby

PZ005- 004

Staff

N/A

N/A

Not used

N/A

N/A

N/A

Derby

PZ005- 005

Staff

N/A

N/A

Practical Skills

No further progress

N/A

N/A

N/A

Derby

PZ005- 006

Staff

N/A

N/A

What is Diabetes

Practical Skills

N/A

N/A

N/A

Derby

PZ005- 007

Staff

N/A

N/A

What is Diabetes

No further progress

N/A

N/A

N/A

Derby

PZ005- 008

Patient

13/07/2017

15

Future complications

No further progress

119

49

N/A

Derby

PZ005- 009

Patient

21/08/2017

2

Adjusting insulin

No further progress

87

76

N/A

Derby

PZ005- 010

Patient

11/09/2017

13

using at home due to connection issues

99

N/A

N/A

Derby

PZ005- 011

Patient

12/09/2017

7


87

N/A

N/A

Derby

PZ005- 013

Patient

02/10/2017

10


109

N/A

N/A

Derby

PZ005- 014

Patient

03/10/2017

10


162

N/A

N/A

Derby

PZ005- 015

Patient

20/10/2017

15


Highs and lows

92

N/A

N/A

Derby

PZ005- 016

Patient

29/10/2017

11


81

N/A

N/A

Derby

PZ005- 017

Patient

06/11/2017

7

What is diabetes

64

N/A

N/A

Derby

PZ005- 018

Used as follow up education

17/10/2016

7

N/A

N/A

N/A

N/A

N/A

Leicester

PZ055- 005

Test

During Illness

Leicester

PZ055- 006

Patient

18/04/2017

13 YRS

During Illness

Adjusting insulin

155mmol

69mmol

36mmol

Leicester

PZ055- 007

Patient

20/04/2017

2YRS

During Illness

No further progress

Leicester

PZ055- 008

Patient

21/04/2017

3 YRS

During Illness

Completed all of it

98mmol

68mmol

38mmol

Leicester

PZ055- 009

Patient

duplicate patient

Food

No further progress

Leicester

PZ055- 010

Patient

24/04/2017

7 yrs

Food

During illness

72mmol

43mmol

39mmol

Leicester

PZ055- 011

Patient

26/04/2017

15 yrs

During Illness

Adjusting insulin

72mmol

46mmol

56mmol

Leicester

PZ055- 012

Staff

Not used

Leicester

PZ055- 013

Patient

02/05/2017

7 yrs

Not used

Leicester

PZ055- 014

Patient

05/05/2017

2 yrs

Practical Skills

During illness

87mmol

68mmol

72mmol

Leicester

PZ055- 015

Patient

05/05/2017

8 months

Practical Skills

No further progress

Leicester

PZ055- 016

Staff

Extreme Highs and Lows

No further progress

Leicester

PZ055- 017

Staff

Food

Leicester

PZ055- 018

Patient

12/05/2017

12 yrs

During Illness

No further progress

98mmol

56mmol

38mmol

Leicester

PZ055- 019

Patient

15/05/2017

10 YRS

Not used

During illness

75mmol

50mmol

Leicester

PZ055- 020

Staff

Food

Leicester

PZ055- 021

Patient

07/06/2017

10 yrs

During Illness

No further progress

Leicester

PZ055- 022

Patient

As above but Dad

As above

but Dad

Highs and Lows and During Illness only completed

No further progress

Leicester

PZ055- 023

Test

Practical Skills

Leicester PZ055- 024

Staff

Practical Skills

Leicester

PZ055- 025

Staff

What is Diabetes

Leicester

PZ055- 026

Patient

01/07/2017

2 yrs

Practical Skills

No further progress

86mmol

62mmol

56mmol

Leicester

PZ055- 027

Patient

02/07/2017

11 yrs

During Illness

No further progress

89mmol

58mmol

50mmol

Leicester

PZ055- 028

Adjusting insulin

Leicester

PZ055- 029

Patient

29/07/2017

10 yrs

What is diabetes

106mm0l

62mmol

55mmol

Leicester

PZ055- 030

wouldn’t work

What is diabetes

Leicester

PZ055- 031

wouldn’t work

Not used

Leicester

PZ055- 032

Patient

25/08/2017

8 yrs

Completed all of it

100mmol

85mmol

74mmol

Leicester

PZ055- 033

Patient

15/09/2017

12 yrs

Practical Skills

Leicester

PZ055- 034

Not used

Leicester

PZ055- 035

Patient

20/04/2017

2 yrs

Completed all of it

84mmol

51mmol

54mmol

Leicester

PZ055- 036

staff

Not used

Leicester

PZ055- 037

Carb counting

Leicester

PZ055- 038

Patient

18/10/2017

12 yrs

Practical Skills

98mmol

Leicester

PZ055- 039

Patient

19/10/2017

14 yrs

Completed all of it

Leicester PZ055- 040

staff

Not used

what is diabetes

Leicester

PZ055- 041

patient

22/10/2017

7 yrs

Not used

what is diabetes

Leicester

PZ055- 042

Patient

22/10/2017

9 yrs

Not used

what is diabetes

Sherwood

PZ180- 002

staff

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Sherwood

PZ180- 003

staff

N/A

N/A

N/A

N/A

N/A

N/A

N/A

Sherwood

PZ180- 004

patient

22/04/2017

16

During Illness

No further progress

113

33

Sherwood

PZ180- 005

patient

28/04/2017

15

During Illness

No further progress

92

83

Sherwood

PZ180- 006

patient

01/05/2017

12

During Illness

No further progress

cant find

52

Sherwood

PZ180- 007

patient

08/06/2017

15

During Illness

No further progress

131

37

Sherwood

PZ180- 008

carer/patient

09/06/2017

5

During Illness

No further progress

101

DNA clinic

Sherwood

PZ180- 009

carer/patient

20/06/2017

5

During Illness

No further progress

88

45

Sherwood

PZ180- 010

patient

01/06/2017

11

What is Diabetes and Food Completed only

Completed all of it

136

64

Sherwood

PZ180- 011

patient/carer

21/08/2017

8

During Illness

Exercise

103

awaiting

Sherwood

PZ180- 012

patient/carer

20/09/2017

6

During illness

141

awaiting

Sherwood

PZ180- 013

patient/carer

13/10/2017

10

Completed all of it

119

awaiting

Appendix 5: Summary of the visuals and the learning resources for all 12 sessions

You can view the actual videos by following these instructions

They are in collections (albums) per session number to try and ensure that they are

watched in the correct order. Each collection is password protected.

The password for all is deapp1

The link below will take you to a list of the collections (they will be formatted in the

correct order):

https://vimeo.com/user63321840/albums/sort:alphabetical/format:thumbnail

If you need to input the address manually just type:

vimeo.com/user63321840/albums

This will show them in a backward order. Click ‘sort: alphabetical’ to put them in a 1 –

12 order if you desire.

Ii

Session one - What is Diabetes

I

I

I

I

.. Glucose • ••

I

I

• • • • • • Ii

Explains what glucose is and what it

does. I Explains what typel diabetes is.

I

I

I

I

I

I

I

· .:: C, •

••

••

••• 0• • ,& I

••. •• •0 o••• • •: W' •• I

$ •• 0 •• . • 0 •• I

I

I

I

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I

I

I

Explains why you have diabetes, lookin g

at your auto immune system.

Talks about Your chances of getting

diabetes.

Explains how a piece of toast is digested

and how it is thenconverted into

energy.

Touches on ketones and how they are

produced and how harmful they can

become.

Explains why the need for a fast (quick)

and slow (long) actinginsulin.

l l

)

.:;;,,

---..-.-- _,... .......

..!.....,. ..!- '

• • ..•..., ,•--

- ..,

• •

.:;;,,

• • •

•

- - ..,

_,, -.., '.,. - ,, .... .,.. · ..

The body map also comes with facial expressions, these can be used to help patients/parent to talk about how they

are feeling after being diagnosed with typel diabetes.

Session one - Learning Tools

The 4 T's thi s reveals the 4 symptoms of diabetes. Tired, thin, thirsty,

toilet. The pat ient/ parent names the symptoms and then peels of a

T to reveal the picture.

The body map can be used in a number of ways. One way is to get the

patient/parent to place the body pieceson the board then talk through the

journey of toast. Explaining how food is broken down and how food containing

carbs are converted into energy.

,

Session Two - Practical Skills

BLOOD GLUCOSE TEST

Explains why it is important to test your

blood glucose levels.

Quality Control Testing

Cr: · 4f,

Explainswhere to give an insulin injection. This video looks at how to prepare an

insulin pen and how it works.

Talksabout Quality control testing and

why its important.

. ·

I I I I II

Looks at how to give an insulin inje ction

Sharps- what is a sharp, what needs to go

in a sharps bin and where to get one from.

Explains the different types of insulin's

that can be used/ prescribed.

Shows how to do a blood glucose test.

Session Two - Learning Tools

Using the equipment your diabetes teamhave demonstrate how to test blood glucose and how to give an

injection.This session also covers how to change an insulin cartridge, lancets and test for ketones.

Injection sites

This is used to ask/show patients

and parents where they can give

an insulin injection.

Sharps or non-sharps

Using the discs ask patient or parent to

throw the correct discs into a demo sharps

bin.

---------

Give the patient or parent the sequence cards and ask them to place them on the board in the

order they feel they should follow if it was them doing a blood glucose test.

I

I

I

I

I

J

Session Three - Food

This video explains that youdon't need a

special diet, it looks at the eat well plate

and its sections.

An insight into what foods contain

carbohydrates.

Explains about good meal times and ideas

on what to have.

This video looks at lactose and fructose.

And long and fast acting foods.

Talks about takeaway's and going out. Explains how to read a food label, and

what to look for.

Session Three- Learning Tools

Using the food cards Patients and parents

can pick out foods that they think contain

carbs.

Patient can also play pairs or snap.

The food plate can be used to get the

patients or parents to choose what they

would like for a meal (using food models)

and talk about what food item would

contain carbs.

You could also use the plate to group the

food models together l:e protein or dairy.

Session Four - Highs & Lows

Explains what a hyper is.

Explains what a hypo is.

This video looks at how to treat a hypo.

· <":, ";

H:. l:i9

I

--"' /4

Session Four - Learning Tools

- •• ,•• H;ghs&lowsd;,csa,eg;,e, ....... _ to the patient or parent to H : lit 1;1:_: 1.1

9 A

l9 . ....• -- 'A9

he lp prompt the start of a

conver sa t ion a bou t t he .; . _ ; . _ ,

sy m ptom s of a high or a low

_l..ivJl

UtN\rM\1'il\M b loo dg lucose r ea d ing. .. ....

•

u••

• ••

••

c ----'e9

W W

S!ood 1 ' 81oud C.lu&..vsc C lc•n e

Tn \ lcSl

QP II QP I , ..._ ......

The time line can be used to look

at when a patient or parent needs

to either give an insulin inject ion

and when to test blood glucose

levels.

t:fttorei,.r.4..'... •ffr.• •

r,.1''

flit'-' J'h rt Sot

Cha r lie's Choice

1. Charlie is going out with nwt es, what sl,ollld h take with him>

Pick items to pack in his , ur• r.2• -

l t,ns ¥•• Keto hi Ml·.1,

Hypol l\" ::,l, ll

l11 L•llfl \n

Wipes or Bot tled Wat,r/ r·ss,·(tn:, finper ),

Mob,(e Pho ne, ldent;f,cat, on.

2. After being out for 2 hours, Charlie start s to fee l thirsty.

What should hedo?

''" rfie•s c'n°' '

Using Charlie and his ruck sack the patient or parent decides

what Charlie needs to take with him when goingfor a walk or

out with his friends.

Readingthroughthe scenarios, the nurse/ educator could

initiate a discussion about what happens next. What would

they do if it was them?

Charlie's Choice I

-

K)

K)

/41mc1.,...-._.. 1

Using the wipe clean board the nurse/educator can ask

the patient or parent to draw where they think a high

blood glucose reading would be.

The nurse/educator can write the expected bloods in the

circles i:e bottom circle 4. Four is the floor

\Q) 7

Using the mat patient or parent can place the hot air balloon

or submarine where they think a high or low blood glucose

reading is. Or what their blood glucose reading is.

/

Session Five - Sick day rules

,v @>&!/

[ Explains about sick day rules,and what to do if they are

ill.

Session Six - DKA

This video looks at DKA, what it is and why it happens.

/'-- -:"K":""e"-ton-es - --

more than1.5 Give a correction of 20'¾ of the total daily dose of Insulin

Session Six - Learning Tools

Traffic light stickers

These can be given to patientsand stuck on the

back of their ketone meter.

Slip in the high blood readingcards .Askthe patient or

parent to roll the dice, if it lands on a high blood glucose

reading and it as ketones ask the patient or parent what to

do.

Session Seven - Correction doses

This video looks at correction doses and how to work

them out.

I Session Seven - Learning Tools

I

I

I

I

I

I

I

I

I

I

I

I The correction ladder will help the patient or parent to be able to work out their own correction dose.

I

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I

/l - :7

<Reading @ r - "

/

Target Level

I

I

I Ses. sion Eight- Carb Counting

I

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- I

Learm·ng Carb values.

I

Session Eight - Learning Tools I

I

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The dieticians will visit the patient or parent and help them to understand carb counting. They use a carb n

cals book, and shr,w them how to weigh foods out and calculate the amount of carbs in that portion.

--- -

Coun t your Corb s & Calories wltnO'f' 1200 food & D1lnk thotoi l

Mn.ff

l(lQJI;

.'

COUNTER CARB & CALORIE

CEREAL

Session Nine - Schools

,;fo1-), I/

Nursery, School, and

College

This video looks at diabetes in schools. Care

Session Ten - Exercise

LearningCarb values.

Session Ten - Learning Tools

Patients or parents roll the dice and depending

what it says th ey need to tell you if they are able

to take part in PE. This prompts discussion about

different types of exercise and how they could

affect their blood glucose readings.

You can also use the diabetescards to prompt the

same discussion.

p,£ Session Eleven - Future complications

I

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COMPLICATIONS I

I

I This video looks at the complications that could happen

due to poor control.

I

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- - - - - - - - - - -

Session Eleven - Learning Tools

These glasses help to give the patient or parent an idea of what it would be like to have the start of eye

Nurse or educator will use these photos to

show the deterioration of a minor foot

problem. This is not meant toscare the

patient or parent but to help them

understand how not looking after their

diabetes could affect them later on in life.

complications. Ask the patient to wear them whilst watching one of the videos on the app. Discuss how they would

feel and what t he y can do to avoid this from happening.

Thefol i-t;serieso, pho( s thedetenor,tbioralOIC'Ol'footinp'v,.. t,ctt ppeflbas1 ofPoOrl)Qbttr:sconuulrm• tJrOe.

Session Twelve - Lifestyle and Travel

LI FESTYLE

Explains that you can still live a normal life, making sure

diabetes doesn't stop you doing anything .

This video looks at travel and what you need to take and

where to store your diabetes equipment.

Twelve - Learning Tools

·carry on'bag 'Check in' bag

-·- What would they need to take on

holiday?

And where would they pack it? Cou ld

it go in the hold or would it have to go

in their cabin bag....

Use this time to talk about different

time zones and relevant travel letters

they made need.

November 2017 Innovating for Improvement · Final report November 2017 Innovating for Improvement...

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