As we approach the winter months, health and social care continues to experience significant demand. There is a need to effectively plan how we use the skills and knowledge of our workforce, to manage capacity in a collaborative manner, leveraging the strengths of each team, service and individual practitioner across the health and social care landscape. ‘Building capacity through the implementation of the National Framework for the Delegation of Insulin Administration’ is a key initiative to support this work in community-based services.
Originally developed in 2020 and launched at the 2020 Chief Nursing Officer Summit by the Head of Community Nursing—Sam Sherrington, the voluntary framework for the delegation of insulin administration was built upon a model policy, supporting material and eLearning, with a dissemination plan originating in exemplar sites and subsequent buddy sites. Shortly after this, the COVID-19 pandemic hit and much of the work was temporarily paused.
In December 2020, the joint statement of intent called upon health and social care organisations in England to work together to encourage the safe delegation of administration of insulin by releasing registered nurses to maximise their contributions elsewhere. It also asked that non-registered staff be equipped with skills that could help reduce unnecessary delays in insulin delivery and improve the quality of care for patients. More recently, the roll out of the framework has been identified as a key priority of the annual Community Nursing Programme 2022-23.
There are several exemplar sites within England, where the value of implementing the framework has been demonstrated. Sheffield, which currently administers over 500 individual injections daily, have identified positive benefits in terms of prioritising registered nurse capacity, supporting workforce recruitment and retention, and enabling healthcare support worker career development. More importantly, for individuals with diabetes, it has reduced anxiety in regards to the timeliness of insulin administration, enhancing continuity and quality of care, as well as the development of therapeutic relationships.
Underpinning these considerations and the implementation of the framework are several principles, that include:
- Safety: according to organisational risk assessment, delegation will not happen if it is not safe
- Patient benefit: the goal of all the changes to ways of working is to continue to improve quality of care and support for patients
- Support staff across social care and health: all changes must empower staff across sectors and respond to staff concerns
- Voluntary and discretionary: delegation of tasks at a system, organisational and individual nurse level will remain voluntary and subject to the discretion of the registered nurse, based on the care plan of the recipient of care, their wishes and the nurse's judgement on the ability of the healthcare assistant to assume new tasks
- Support of regulators: all changes must have been agreed with the relevant quality and performance regulators (Nursing and Midwifery Council, Care Quality Comission, Health and Care Professional Council) and professional bodies (e.g. Royal College of Nursing, Scottish Funding Council), which have contributed to the programme's development
- Training and support in place at all levels: changes must be supported by adequate materials and advice to assist the safe implementation at a local level. These will be co-produced with clinicians and social care staff.
Supporting the implementation of the framework are a number of resources, refreshed in November 2022, which draw upon key elements of existing good practice and can be found at: Delegation of Insulin Administration. This includes a sample policy for delegation of administration of insulin to adults, a competency framework and workbook, an organisational checklist, a health and care worker checklist, a series of frequently asked questions, a supporting eLearning module and a series of webinars.
There are five steps to work through, for those organisations that are interested in implementing the framework:
- Agree that there is a need for a change in practice
- Download the documents from the Diabetes UK website
- Train the relevant staff and sign off competencies
- Roll out to teams and caseloads
- Evaluate and gather data to demonstrate impact.
For organisations who would like further information initial enquires can be directed to Lesley Mills Community Nurse Clinical Fellow/Consultant Nurse in Diabetes at lesley.mills3@nhs.net