Developing Clinical Guidelines to Improve the Care of Older People With Diabetes

2.50
Hdl Handle:
http://hdl.handle.net/10755/621484
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Developing Clinical Guidelines to Improve the Care of Older People With Diabetes
Other Titles:
Gerontological Nursing Care
Author(s):
Dunning, Trisha Lynette
Lead Author STTI Affiliation:
Non-member
Author Details:
Trisha Lynette Dunning, PhD, MEd, AM, RN, CDE, ACN-DLF, Professional Experience: Registered nurse with a joing clinical and academic appointment for the last 20 years. Extensive experinece in diabetes education and managing older people with diabetes. Author Summary: Professor Dunning is the Chair in Nursing at Deakin University and Barwon Health, Australia. She is internationally recognised for her work in diabetes education and care through national and international speaking engagements and publications. She was an international Vice President 2010-2015 She was honoured by the Australain Government in 2004 whe she was made a Member of the Order of Austraila.
Abstract:

Background

Diabetes is associated with functional, cognitive, and social changes. Polypharmacy and under-or malnutrition, pain, depression, falls, confusion, delirium and significant medicine-related adverse events including hypoglycaemia are common (Munshi et al. 2016). There are a number of existing guidelines for the care of older people with diabetes but conversations with staff caring for caring for older people with diabetes indicated that such guidelines do not address core components of the care such as sexual health and end of life. There is limited clinical trial evidence to support recommendations and low regard for expert/consensus opinion. Older people with diabetes are often excluded from studies: when they are included they were basically healthy and prescribed none or only one medicine (Bayer & Tadd 2000).

Aim

 a) Develop a guideline development framework that followed National Health and Medical Research (NHMRC) clinical guideline development recommendations (NHMRC 1998).

b) Engage key stakeholders (older people with diabetes and health professionals) in the development process.

c) Determine the value of consensus/expert opinion when developing guidelines CPGs.

Method

We followed the National Health and Medical research council (NHMRC) clinical practice guideline development recommendations. We conducted a structured literature review, appointed an expert advisory group and subjected the draft guidelines to peer-review. In addition to the NHMRC recommendations, we formally evaluated the Guidelines in four small rural and one large metropolitan aged care facilities before they were released into the public domain. Data were collected using anonymous self-completed questionnaires and interviews with staff and older people with diabetes before and nine months after the guidelines were distributed to the care homes and staff used them to plan care. A medical record audit was undertaken to ascertain whether the guidelines were used to plan care. In addition, the guidelines were subjected to external peer review by international experts in the care of older people with diabetes.

Results

Very few randomised controlled trial were identified, therefore most of literature was graded at level 3 or 4. Eighty nine residents: 58% female, 82% had type 2 diabetes, all had at least one diabetes complication. Thirty one staff members, mostly nurses, participated. There was some evidence from the medical record audit that some guidelines influenced care, especially the risk hypoglycaemia and medicine adverse event assessment tools that form part of the guidelines. The advice from the Expert Advisory Group (consensus opinion) and evaluating the guidelines in the clinical settings they were designed for enhanced their value and played a valuable role in the content validity and clinical relevance of the final Guideline, the McKellar Guideline. A key outcome of the staff evaluation was a suggestion to include information about how staff could use the document to plan care. Consequently, an accompanying document, The McKellar Way, which suggests strategies for implementing the Guideline recommendations to personalise care, was developed (Dunning et al. 2013).

Impact and outcomes:

  • A suite of information that consists of a philosophical framework to guide care (Dunning et al. 2013),
  • Clinically relevant, usable clinical guidelines for managing older people with diabetes: The McKellar Guidelines (Dunning et al. 2013; The McKellar Way (Dunning et al. 2013).
  • Awarded the Barwon Healthcare Innovation Award for Excellence in Healthcare.
  • Became policy in our health service in a large regional/rural area in 2014.
  •  The Guidelines are cited in and were the basis for the older person section in the Australian Government National Diabetes Strategy 2016–2020 released on World Diabetes Day, 2015.
  • Medical record audits undertaken before the Guidelines were implemented in 2014 and approximately nine months after implementation show changes consistent with Guideline recommendations in residents’ care plans, including evidence that care is based on Guideline recommendations and is being personalised.
  • Staff is required to attend annual professional development sessions that are based on the Guidelines,
  • The Guidelines are being implemented in various other Australian and some international practice settings
  • The risk assessment tools in the Guidelines were translated into Norwegian.
  • Discussions about translating the Guidelines into Chinese were held with a Chinese geriatrician.
  • The Chief investigators mentored beginning researchers to build research capacity.
  • Clinical indicators were developed and will be evaluated in a follow up study.

Conclusions

The guideline development process combined several strategies with the NHMRC recommendations, namely key stakeholder engagement throughout the development process, which enabled methodological issues to be addressed. It resulted in clinically relevant guidelines for caring for older people with diabetes that meet stakeholders’ needs and have been translated into and changed practice. Combining consensus/expert opinion with clinical evidence engages key stakeholders and contributes valuable practical information not reported in clinical trial.

Keywords:
Clinical Guidelines; Diabetes; Older people
Repository Posting Date:
14-Jun-2017
Date of Publication:
14-Jun-2017
Other Identifiers:
INRC17N06
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleDeveloping Clinical Guidelines to Improve the Care of Older People With Diabetesen_US
dc.title.alternativeGerontological Nursing Careen
dc.contributor.authorDunning, Trisha Lynetteen
dc.contributor.departmentNon-memberen
dc.author.detailsTrisha Lynette Dunning, PhD, MEd, AM, RN, CDE, ACN-DLF, Professional Experience: Registered nurse with a joing clinical and academic appointment for the last 20 years. Extensive experinece in diabetes education and managing older people with diabetes. Author Summary: Professor Dunning is the Chair in Nursing at Deakin University and Barwon Health, Australia. She is internationally recognised for her work in diabetes education and care through national and international speaking engagements and publications. She was an international Vice President 2010-2015 She was honoured by the Australain Government in 2004 whe she was made a Member of the Order of Austraila.en
dc.identifier.urihttp://hdl.handle.net/10755/621484-
dc.description.abstract<p><strong>Background</strong></p> <p>Diabetes is associated with functional, cognitive, and social changes. Polypharmacy and under-or malnutrition, pain, depression, falls, confusion, delirium and significant medicine-related adverse events including hypoglycaemia are common (Munshi et al. 2016). There are a number of existing guidelines for the care of older people with diabetes but conversations with staff caring for caring for older people with diabetes indicated that such guidelines do not address core components of the care such as sexual health and end of life. There is limited clinical trial evidence to support recommendations and low regard for expert/consensus opinion. Older people with diabetes are often excluded from studies: when they are included they were basically healthy and prescribed none or only one medicine (Bayer & Tadd 2000).</p> <p><strong>Aim</strong></p> <p> a) Develop a guideline development framework that followed National Health and Medical Research (NHMRC) clinical guideline development recommendations (NHMRC 1998).</p> <p>b) Engage key stakeholders (older people with diabetes and health professionals) in the development process.</p> <p>c) Determine the value of consensus/expert opinion when developing guidelines CPGs.</p> <p><strong>Method</strong></p> <p>We followed the National Health and Medical research council (NHMRC) clinical practice guideline development recommendations. We conducted a structured literature review, appointed an expert advisory group and subjected the draft guidelines to peer-review. In addition to the NHMRC recommendations, we formally evaluated the Guidelines in four small rural and one large metropolitan aged care facilities before they were released into the public domain. Data were collected using anonymous self-completed questionnaires and interviews with staff and older people with diabetes before and nine months after the guidelines were distributed to the care homes and staff used them to plan care. A medical record audit was undertaken to ascertain whether the guidelines were used to plan care. In addition, the guidelines were subjected to external peer review by international experts in the care of older people with diabetes.</p> <p><strong>Results</strong></p> <p>Very few randomised controlled trial were identified, therefore most of literature was graded at level 3 or 4. Eighty nine residents: 58% female, 82% had type 2 diabetes, all had at least one diabetes complication. Thirty one staff members, mostly nurses, participated. There was some evidence from the medical record audit that some guidelines influenced care, especially the risk hypoglycaemia and medicine adverse event assessment tools that form part of the guidelines. The advice from the Expert Advisory Group (consensus opinion) and evaluating the guidelines in the clinical settings they were designed for enhanced their value and played a valuable role in the content validity and clinical relevance of the final Guideline, the McKellar Guideline. A key outcome of the staff evaluation was a suggestion to include information about how staff could use the document to plan care. Consequently, an accompanying document, The McKellar Way, which suggests strategies for implementing the Guideline recommendations to personalise care, was developed (Dunning et al. 2013).</p> <p><strong>Impact and outcomes:</strong></p> <ul> <li>A suite of information that consists of a philosophical framework to guide care (Dunning et al. 2013),</li> <li>Clinically relevant, usable clinical guidelines for managing older people with diabetes: The McKellar Guidelines (Dunning et al. 2013; The McKellar Way (Dunning et al. 2013).</li> <li>Awarded the Barwon Healthcare Innovation Award for Excellence in Healthcare.</li> <li>Became policy in our health service in a large regional/rural area in 2014.</li> <li> The Guidelines are cited in and were the basis for the older person section in the Australian Government National Diabetes Strategy 2016–2020 released on World Diabetes Day, 2015.</li> <li>Medical record audits undertaken before the Guidelines were implemented in 2014 and approximately nine months after implementation show changes consistent with Guideline recommendations in residents’ care plans, including evidence that care is based on Guideline recommendations and is being personalised.</li> <li>Staff is required to attend annual professional development sessions that are based on the Guidelines,</li> <li>The Guidelines are being implemented in various other Australian and some international practice settings</li> <li>The risk assessment tools in the Guidelines were translated into Norwegian.</li> <li>Discussions about translating the Guidelines into Chinese were held with a Chinese geriatrician.</li> <li>The Chief investigators mentored beginning researchers to build research capacity.</li> <li>Clinical indicators were developed and will be evaluated in a follow up study.</li> </ul> <p><strong>Conclusions</strong><strong></strong></p> <p>The guideline development process combined several strategies with the NHMRC recommendations, namely key stakeholder engagement throughout the development process, which enabled methodological issues to be addressed. It resulted in clinically relevant guidelines for caring for older people with diabetes that meet stakeholders’ needs and have been translated into and changed practice. Combining consensus/expert opinion with clinical evidence engages key stakeholders and contributes valuable practical information not reported in clinical trial.</p>en
dc.subjectClinical Guidelinesen
dc.subjectDiabetesen
dc.subjectOlder peopleen
dc.date.available2017-06-14T13:55:26Z-
dc.date.issued2017-06-14-
dc.date.accessioned2017-06-14T13:55:26Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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