Dr Trudi Deakin BSc, AdDip, PGCE, PhD RD The X-PERT Programme A Structured Patient Education Programme for People with Diabetes Leading the Way to Healthy Living with Diabetes Quality Assurance Annual Structured Education Conference Birmingham 1 st December 2008

Programme description Purpose and objectives of Quality Assurance (QA) How long has the QA been in place? Numbers of educators who have been trained in programme and numbers of educators who have been through the QA process QA Process – description, strengths and challenges QA – outcomes and evidence

WK1 - 6LSE Based on empowerment, learner-centred education & activation – discovery learning ‘Helping people discover and use their innate ability to gain mastery over their diabetes’ Anderson and Funnell (2005) The Art of Empowerment: Stories and Strategies for Diabetes Educators, American Diabetes Association Fourteen hours structured education One trained educator Group sizes participants plus carers

What is Diabetes

WEIGHT MANAGEMENT

CARBOHYDRATE AWARENESS Quantity of CHO is the key strategy Quality of CHO offers additional benefits

SUPERMARKET TOUR Guide to Food Labelling A lot A Little 10.0g of sugars 2.0g of sugars 20.og of fat 3.0g of fat 5.0g of saturates 1.0g of saturates 3.0g of fibre 0.5g of fibre 0.5g of sodium 0.1g of sodium

POSSIBLE COMPLICATIONS This session is intended to be informative without being too alarming. Activity one starts with a group activity to define hypoglycaemia, hyperglycaemia and to discuss how to reduce the risk of these short-term complications of diabetes. Activity two aims to present the facts of the potential longerterm problems of diabetes. Visual aids have been developed to explain complex conditions such as cardiovascular disease, nephropathy, neuropathy and retinopathy in simple terms.

X-PERT Game Designed to recap on main messages. It’s fun and helps to increase skills, knowledge & confidence in making informed decisions regarding diabetes self-management.

Anderson and Funnell (2005) The Art of Empowerment: Stories and Strategies for Diabetes Educators, American Diabetes Association 5 step empowerment model 1.Identify the problem 2.Explore that problem 3.Possible solution 4.Commitment to action 5.Evaluate Why do you want to do the experiment? Is it worthwhile? If it is, it needs to be SMART S – specific………………… what are you going to do and when? M – measurable…………… time, place, frequency etc. A – achievable……………… on a scale of 0 – 10, how confident are you that you can achieve it? R – realistic………………… can it be continued long-term? i.e. several years? T – time…………………….. time scale for experiment & goal?

Having too much quick releasing CHO? Need to Reduce Portions? Active enough? Increase low GI CHO? Taking treatment Correctly? Health Professional No Yes No Yes Possible to  activity levels? No YesNo Self – Management Skills For Diabetes HbA1c too high? Self-management form BGL’s too high Pre/2 hr post meals? Eating too much CHO? Yes 8%

Improve diabetes control Are you: * eating too much? * eating at the right time? * eating too many high GI foods? * a sensible body weight? * taking your medication correctly? Do you need extra / different medication? Can you increase your physical activity level? Lower your blood pressure Are you * adding salt to your meals? * eating too many salty foods? * having enough fruit/veg/dairy food? * drinking too much alcohol? * Overweight / inactive? * taking your blood pressure medication? Do you need medication / extra medication? Lower your LDL cholesterol Watch your fat intake Reduce saturated fat Obtain a sensible weight Increase physical activity Lower your Triglycerides Try eating oily fish Lower your blood glucose levels Are you eating too many sweets? Drink less sweet liquids- including unsweetened juice Watch your alcohol intake Lose Weight Do you do enough physical activity? Is your diet too fatty? Are your portion sizes too big? Do you eat regular meals? Do you drink too much alcohol? Lower your cholesterol level Do you * eat too much saturated fat? * eat enough soluble fibre? * carry extra body fat? * take your medication? * need medication? Increase HDL (good) cholesterol Do you take enough exercise? Do you need to lose weight? Can you lower triglycerides? Have a small amount of alcohol

Glycated Haemoglobin Systolic Blood Pressure Diabetes Empowerment Score Diabetes Knowledge Score Quality of Life Self-Management Skills Clinical Lifestyle Psychosocial Body Mass Index Lipid profile Food and Nutrients Treatment Satisfaction Participant Evaluation Baseline Characteristics

X-PERT Audit - December 2008

Consistent messages Informed choices Diverse populations Vision = Common Language FUN

Internal Q.A. Self reflection diary What did I do well? What didn’t I do so well? What can I do differently next time?

External Q.A Environment Structure Process/Programme Delivery Content Evaluation & Outcome Information Score > 80% no need to QA for another 3 years Score < 80% = agreed action plan & re quality assured within 1 year

Example 1 X-PERT educator - Which of the 3 nutrients has a direct affect on blood glucose levels? Participant – Fats X-PERT educator – No, that is not correct, the answer is carbohydrate. Carbohydrates include starchy foods such as potatoes, rice pasta & bread, sugary foods such as cakes, biscuits and naturally sweet foods such as fruit and milk. These foods break down and directly affect blood glucose levels. Once in the blood the glucose is needed for energy and insulin is needed for the glucose to enter the cells. This is represented as a key.

Example 2 X-PERT educator - Which of the 3 nutrients has a direct affect on blood glucose levels? Participant – Fats X-PERT educator – Yes, I can see why you may think that and in a way you are correct, fats, like any of the nutrients if eaten in excess can cause weight gain which in the long term can affect blood glucose control buts there is only 1 nutrient which directly affects blood glucose levels and that is? Participant – Carbohydrates X-PERT educator – That’s right, and which foods contain carbohydrates? Participants – Bread, pasta, rice, potatoes, fruit, cakes, biscuits, milk

Strengths 2 way learning process Good to be quality assured by another X-PERT educator so that they can learn from each other – constructive feedback Non threatening and encourages continual quality improvement

Challenges Self-directed No inspection QA available Sept X-PERT Educators ?? No national QA report

The Way Forward Audit Database Reports Best Practice Guidelines Share self-reflection experiences Annual E Learning

Structured Patient Education new scary different way of working BUT effective cheap, no –ve side effects makes a difference! Website