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MA Healthcare – Diabetes Nursing

MA Healthcare – Diabetes Nursing

LESLEY MILLS [00:00:04] Hello, my name is Lesley. I’m a consultant nurse working in the north of England. I’ve worked in diabetes for over 25 years. And joining me today are my colleagues, Sarah. Linda.

SARAH COE [00:00:17] Hi, I’m Sarah. I’m a diabetes specialist nurse. I work in secondary care in a hospital setting. I’m looking after my acutely unwell patients.

LINDA NAZARKO [00:00:27] And I’m Linda. I’m a nurse consultant working in North West London. I work in a trust which cares for people with mental health problems and with people accute mental health problems and also people in the community with mental health problems and also general community patients. Thank you.

LESLEY MILLS [00:00:44] So thanks, everyone, for joining us today for this webinar. We’re here to discuss needle-stick injuries in relation to diabetes care and in partnership with Independent Nurse Practice Nursing and The Journal of Nursing. So the aim of the discussion today girls is to raise awareness of needle-stick injuries within diabetes care. Obviously, we are aware that needle-sick injuries is not a new phenomena and to some extent safety concerns, needle-stick injuries and has come a long way in the last 5 years and considerable changes have been made in the workplace. However, these needle-stick injuries are still very much common occurrence. Their serious concern for nurses and other health care professionals and general health care workers. One of the main political risks is obviously from a needle-stick injury is infection, blood borne diseases such as HIV and hepatitis. Exposure to blood borne pathogens has been obviously a devastating to healthcare workers and their families. Infection prevention units and occupational health teams devote a significant portion of time and of their practice on minimizing these exposures. But it’s still needle-stick injuries occur and obviously are and they are the most effective method for transmitting blood borne pathogens between patients and healthcare professionals. And basically, you know, the stats speak for themselves. We know that almost a third of nurses that were surveyed were had experienced some sort of needle-stick injury in the past while giving an injection of insulin. We know that 1 in 10 nurses actually were injured by the cartridge end of the needle. And we’ve got nearly 2000 claims through NHS resolutions between 2012 and 2017 at a cost to the NHS of over 4 million pounds. So financial burden, psychological burden and physical burden. Which leads us on really to, you know, insulin is a very high risk procedure for the individual that’s giving that insulin. Because of those numbers of injections that are required and therefore increase the risk of lack of training and understanding of safety devices. And on the topic of training, we now hear from Aly from BD, who’s us with a short video around what they can do to be- what training can be done to be offered to us all.

ALYSON GERRISH [00:03:34] My name is Aly Gerrish and I am a trainer for a B2 Medical, Diabetes Care. My working day is spent in the hospital on community basis throughout the UK and Ireland, interacting with diabetes teams and nursing staff to deliver tailored face-to-face training sessions regarding ought she’ll do safety pin needles. Some of you may recognise me. I have a very interesting job. Every week, I meet hundreds of hardworking nurses and some of them tell me of their experience with needle-stick injury first hand, how it made them feel, how it affected their families. Some needle-stick injuries were from the single ended safety needles. Both ends of the needle must be protected. Our staff will still experience needle-stick injury. My daily experience has also taught me that it is simply not enough to provide quality safety pin needles. In other words, it doesn’t matter how good your pin needle is. Insulin delivery will never be effective if your injection technique is pure. Pure insulin delivery has consequences for patients in terms of lack of glycemic control and undesirable long term outcomes. So good technique is really important. Injection technique training is often way at the bottom of the to do list. In the current busy NHS environment, can you remember when you were last taught best practice injection technique? BD have the expertise and the experience to partner with you to deliver short effective injection technique educational sessions for your staff. We have tried and tested standard operating procedures aligned to the current health and safety, sharp instruments in health care regulations. That’s 2013. We have developed a step by step training program to help ensure nursing staff are delivering injections in the safest way possible. Our training provides expert knowledge on delivering insulin injections safely in line with the current Sharp’s regulations. I can integrate with your Safer Working Environment Program regarding needle-stick injury prevention. Training is delivered in a variety of formats. Instructor led, web based and online educational material. BD are committed to improving insulin delivery and are ready to partner with you to improve outcomes for your patients. We can also help you achieve your goals regarding current Sharp’s regulations. So let us support you and keep you safe.

LESLEY MILLS [00:05:59] Okay. Thanks, Aly. So we’ve heard about what the burden is and obviously, you know, Aly’s mentioned about the training, but let’s talk about what really happens in practice and Sarah, have you got any examples?

SARAH COE [00:06:17] One of the examples that I can say is mainly about patients in the hospital. This patient actually was self administering their insulin. Excuse me. And what they did is after the injection, they left the needle on on the pen. They then put the pen on their tray table by their bed. In due course, they’d covered the needle and the pen with paperwork. And as a nurse came round to tidy up, she was unaware that this pen with the needle still attached was underneath there. And as she cleared up, she actually ended up with a needle-stick injury. Now, this kind of needle-stick injury, Leslie, would be really around the fact that this patient was probably not really educated on what they needed to do with that needle. And maybe they were not given the right equipment or if they were, they hadn’t been shown what to do with it. So education here is really important and providing the patient with the right equipment to dispose of that needle. So going forwards, I think we’ve got education is very important in this incident.

LESLEY MILLS [00:07:27] Absolutely. What about you, Linda?

LINDA NAZARKO [00:07:29] Well, a very, very similar incident in a community setting where a health care support worker was injured by a needle. And that I mean, you talked about the financial cost, but the human costs are absolutely incalculable. First of all, the person with diabetes to win advertently caused the needle-stick injury was devastated. Then the health care support worker had to have blood tests and actually had to endure a 3 week, 3 month wait until she found it. She was clear and didn’t have hepatitis or any blood borne viruses such as HIV. So it’s all about absolutely education, but also it’s about education, but it’s also about ensuring that people do safely dispose of sharps and that they are aware that it can have life changing consequences.

LESLEY MILLS [00:08:14] Absolutely. Absolutely. I think we’ve all experienced those sorts of scenarios in our own workplaces, whether they’ve been in the community or in secondary care. So what can we do? What can we do? What are the solutions.

SARAH COE [00:08:28] So one solution is looking at the safety needles. So insulin pen safety needles. So you already mentioned earlier on the one in 10 nurses actually get their needle-stick injury from the cartridge under the needle. So having a device that is a jewel ended safety needle. So you have one end of the needle, which is the end where you perform the injection with is covered and locked, but also the other end becomes protected and locked as well. So when you have the needle after it’s been used, there’s no chance of any needle-stick injury because both ends are protected. And subsequently, the nurse or health care professionals also protected as well.

LINDA NAZARKO [00:09:09] Great. It’s also about education and training. And that has got to be ongoing because in health care, we have people who move from organization to organization. We have newly registered nurses and we have internationally recruited nurses as well, who may never have seen a safety needle before. So ongoing education and training and also the availability of refresher training for people who might not have given insulin for whatever reason for a while.

LESLEY MILLS [00:09:34] Yeah. And I think it’s important that it’s not just a one off, is it? This needs to be a rolling program. This needs to be continuously, you know, checked out to refresh to ensure that the competencies are ongoing. And the turnover staff, you know, we all know, you know, I know from my own personal experience of working in secondary care and in primary care, the staff move away and they have to do the the whole training project again, you know, project again. So it’s really important that this is an ongoing…

LINDA NAZARKO [00:10:10] And we can all do with a bit of a refresher from time to time.

SARAH COE [00:10:13] To know where to get the training from as well, who to speak to about the training. So contacting their manager, and the manager, contacting either the diabetes specialist, nurse or linked nurse within the trust or even going to BD who offer for the comprehensive training program, as Aly had mentioned in her video.

LESLEY MILLS [00:10:32] Yeah, great. So I think it’s really important to keep in mind that, you know, this is, as you’ve mentioned, as is physical and psychological burden. It’s a financial burden as well. And we need to ensure that we improve. You know, we have made some improvements but we need to continue to make those improvements…

LINDA NAZARKO [00:10:56] As we take of our patients. We should also take care of our colleagues. Yes. I mean, that is so, so important.

LESLEY MILLS [00:11:04] Well, thank you, girls. I’ve got a few questions which I’d like to throw out to you, too. I think first one, Sarah, whilst given an insulin dose. I had the needle click and we tracked what do I do?

SARAH COE [00:11:20] Okay. So using the jewel ended safety device, obviously when the needle has been used and then retracted, it locks. So occasionally this can happen during the middle of an injection. It may be that the patient moved. It may be that the pen wobbled. There could be a number of reasons. But if this happens, it’s important not to panic about it. And just to safely remove the injection and have a look. If your dose hasn’t gone all the way through. Do not redial the… original dose. Keep it. It is change to the age of a new one. I continue the injection for the rest of the units that need to go through. This way. You know, the patient has had some insulin. We don’t know exactly how much they’ve had, which means we will need to monitor their glucose levels probably a little bit more closely afterwards. But what we don’t want to do is redial all that dose back up to the original amount and give them again, because by that we may well be giving them too much insulin and putting them at risk of hypoglycaemia.

LESLEY MILLS [00:12:24] Yeah, yeah, absolutely. Linda, I’ve just started on the ward and we use safety needles. I’m not comfortable with using them. What should I do?

LINDA NAZARKO [00:12:34] Well, you’re not alone. We hear this so, so very often. So the first thing is don’t give any injections because you shouldn’t do anything that you’re not confident and competent to do so. Speak to ward manager. Your ward manager will be able to tell you we’ll be able to direct you to the appropriate training. This may be delivered via diabetes champion on the ward. It may be delivered via your diabetes nurse specialist, but your ward manager will be the first person to do that. When you’ve actually had the training. Then you will know what to do. But you can also seek the support of experienced colleagues on the ward so that you actually develop confidence and competence. And don’t forget to have a refresher training anytime you feel you need it.

LINDA NAZARKO [00:13:16] Yeah. And I think I mean, would you say that goes for community nurses and the health care workers as well? Or is there anything different that we need to think of?

SARAH COE [00:13:25] No. I completely agree. All healthcare professionals, anybody using any kind of medical device, not just the safety needles, should ensure they’re properly trained and they’re confident in how they’re using it to ensure that the individual that they’re then working with is going to have the optimum treatment that they need. And it’s done safely.

LESLEY MILLS [00:13:47] Yeah. Yeah. I think that leads us on to a nice question around should safety needles be used by everyone? And I would say no. They should only be used in those individuals who cannot give the insulin themselves. So, for example, if a third party and other person has to give that insulin to that individual, then that’s the time. If the individual can take the needle, put the needle on and take it off themselves. They don’t need to use knife to needle. Would you agree?

LINDA NAZARKO [00:14:15] Totally. And it’s also much more economical. Yeah. Yeah.

LESLEY MILLS [00:14:19] Okay. So last question. What else can we do, too- what else can be done to reduce the risk of needle stick injuries?

LINDA NAZARKO [00:14:27] Well, first of all, it’s really, really important that people are properly trained. They have and they have appropriate support afterwards.

SARAH COE [00:14:39] Ensuring the correct equipment is available for them. And they’ve been, as I say, educated and trained to use that equipment properly, whether that’s the needles themselves or whether that’s the disposal of the needles, sharps, bins, etc..

LESLEY MILLS [00:14:54] Yeah, yeah. And I think sport overall, isn’t it?

LINDA NAZARKO [00:14:57] Yes.

LINDA NAZARKO [00:14:58] So we’ve got the education in regard to how to use the device. We’ve got the training, whether that’s face-to-face online, etc. And then it’s about correct disposal of that device isn’t it? And making sure that everybody then in our family is protected from a needle stick injury.

SARAH COE [00:15:17] And just one other point as well with regards to the actual sharp spin. So when we’ve disposed the needle that those shots been incorrectly, assembled and they’re actually stored safely as well to make sure that nobody has any problems with those afterwards as well.

LESLEY MILLS [00:15:34] Absolutely. Absolutely. Well, thank you, girls. Thank you. I hope you’ve enjoyed this discussion today. If you would like any further resources, please head over to the resource section on this webinar and also you’ll be able to print off a certificate for your CBD. Thank you.