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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
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
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
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 [email protected]