Step 4. Testing changes

Making change is not limited to one person/role. Everyone involved in the care of those with T2DM has a role. However change ideas need to be tested to determine what works well and is sustainable.

Suggested actions - testing changes

Before making changes/starting a new process: define your current process, what works well, what could be better? Always remembering that the aim of implementing the prescribing guidance is improving care of those with T2DM.

• Process map
• Pareto chart
• Cause and effect analysis 
• SWOT analysis

There may be more than one change required.

Consider the location

The location of the review will determine the type of review (ad hoc or planned); staff involved; preparation required (e.g. bloods, measurements); single disease or polypharmacy. Define all the steps and people involved.

• Planned – acute setting: diabetic clinic – focus on diabetes including hypertension, cardiovascular risk. May not include other co-morbidities.
• Planned – primary care: Diabetic clinic or all chronic disease management.
• Ad hoc – acute setting: During acute admission for diabetes complication/adverse event or other, e.g. surgery.
• Ad hoc - primary care: When other change in medication occurring; acute condition/minor illness, e.g. osteoarthritis flare up.

Regular medication review is essential to ensure all medication continues to be appropriate and any changes in clinical conditions are managed appropriately.  The 7-Steps medication review process improves clinical outcomes and reduces harm. Medication review can be planned or ad hoc and will often depend on the setting and service user group.

Suggested actions - testing changes

Consider the review process and the 7-Steps medication review

Current guidance

• Diabetes Quality Prescribing Guide
• Right Decisions app

Training and case studies

• Case studies in Diabetes Quality Prescribing Guide
• Polypharmacy guidance including 7-Steps medication review process, this includes a template for a 7-Steps medicine review
• Evidence Based Polypharmacy Reviews and the 7-Steps Process (CPD accredited online training on Turas)
• Turas Shared Decision Making
• NES Diabetes modules (available via Turas)

Treatment summaries

• Treatment algorithm and summary charts (full table, renal disease, frailty) in Diabetes Quality Prescribing Guide

Patient guides

• Manage meds - for patients and carers

• MyDiabetesMyWay – Scotland’s interactive diabetes website

Ensure follow-up

• Ideally after 3 months if changes made to medication HbA1c

• The House of Care Model - Health and Social Care Alliance Scotland
• Medication sick day guidance postcard manual from the Manage Meds app
• Quality improvement in diabetes care | Diabetes UK

Measurement

• Use data to monitor progress and tell other of the impact of your changes.
• Use a measurement plan to outline what types of data to collect, how and when to collect it and how it will be analysed and presented.
• These measures will be key to understanding the impacts – planned or unplanned – that your change ideas are having.
• Populate the measurement plan or other tracking device with details from:
  • STU data
  • NTIs
  • Patient feedback