Dr Trudi Deakin BSc, AdDip, PGCE, PhD RD

The X-PERT ProgrammeA Structured Patient Education

Programme for People with Diabetes

Leading the Way to Healthy Living with DiabetesQuality Assurance

Annual Structured Education ConferenceBirmingham 1st 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 - 6 LSE

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 15-18 participants plus carers

What is Diabetes

WEIGHT MANAGEMENT

CARBOHYDRATE AWARENESS

Quantity ofCHO is the

key strategy

Quality of CHO offers

additionalbenefits

SUPERMARKET TOUR

Guide to Food Labelling

A lot A Little10.0g of sugars 2.0g of sugars

20.og of fat 3.0g of fat5.0g of saturates 1.0g of saturates

3.0g of fibre 0.5g of fibre0.5g 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 model1. Identify the problem

2. Explore that problem3. Possible solution

4. Commitment to action5. 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 ReducePortions?

Active enough?

Increase low GI CHO?

Taking treatmentCorrectly?

Health Professional

NoYes

No

Yes

YesPossible to activity levels?

No

Yes No

Self – Management Skills For Diabetes HbA1c too high?

Self-management form

BGL’s too highPre/2 hr post meals?

Eating too much CHO?

Yes

Yes

8%

Improve diabetes controlAre 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 pressureAre 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 cholesterolWatch your fat intakeReduce saturated fat

Obtain a sensible weightIncrease physical activity

Lower your TriglyceridesTry eating oily fish

Lower your blood glucose levelsAre you eating too many

sweets?Drink less sweet liquids-

including unsweetened juiceWatch your alcohol intake

Lose WeightDo 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

ParticipantEvaluation

BaselineCharacteristics

X-PERT Audit - December 2008

Consistent messagesInformed choices

Diverse populationsVision = 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 2005

• 752 X-PERT Educators

• ?? No national QA report

The Way Forward

• Audit Database Reports

• Best Practice Guidelines

• Share self-reflection

experiences

• Annual E Learning

www.xperthealth.org.uk

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

Website http://www.xperthealth.org.uk Email trudi.deakin@xperthealth.org.uk