Diabetes in Domiciliary Care Policy

Cavendish Homecare believes that every person has the right to the highest possible quality of care in the management of their health needs.

This document is intended to set out the values, principles and policies underpinning Cavendish Homecare’s approach to the care of people with diabetes who our services.

This policy is designed to be compliant with the Diabetes National Service Framework (NSF).

Policy Background

Cavendish Homecare understands that diabetes is a long-term condition in which the amount of glucose in the blood is too high because the body does not produce enough insulin to be able to use it properly.

There are two main types of diabetes.

Type 1 diabetes.
Type 2 diabetes.

Type 1 diabetes is usually treated by insulin injections and changes to the diet while type 2 diabetes is treated with lifestyle changes such as a healthier diet, weight loss and increased physical activity and medication to restore normal blood glucose levels.

Self-care of Diabetes

A key component of the Diabetes NSF is the empowerment of people with diabetes to look after themselves as far as possible. This is a vital element in enabling those receiving domiciliary care to live with dignity, self-determination and independence. Cavendish Homecare staff will therefore be expected to support the self-caring capabilities of people who use our service wherever possible.

Assessment

All diabetics people should be assessed for their capability in being able to self-care and to determine what support they require. If a person develops diabetes during their care an assessment will be conducted in partnership with their GP and with any specialist diabetes care services involved.

The initial assessment should be designed to elicit exactly how much support the person will need in coping with their diabetes and to identify who should do what in providing care. The results of the assessment should be entered into their Care Plan.

The assessment may identify the need for one of the following typical patterns of care:

the client may safely maintain control of their diabetes
the client may be able to take partial control over some aspects of their diabetes care and who will need support and monitoring by care staff
the client may need support on a temporary basis but who will be able to resume control as soon as possible
the client may be unable to take full control of their diabetes and will therefore need arrangements to be made for support and care to be provided by specialist diabetes services

Care Protocol for People with Diabetes

Cavendish Homecare’s clients with diabetes can expect:

to be encouraged to play an active role in their own care relative to their overall level of independence
to have an individualised Care Plan which they themselves have played a key part in developing along with any members of their family and/or advocates that they wish to be involved
to have an individualised dietary and nutritional plan agreed with them
to have an annual review involving their GP and other essential members of the community health team
access to community health professionals such as a dietician, podiatrist and an optometrist
access to consultant specialist care by direct referral from the GP or by an agreed community health professional.

Diabetes Care Planning

Domiciliary care staff should:

deliver high-quality care in accordance with the clients’ Care Plan
support people’s capacity for self-care in health matters
be thoroughly familiar with and observe at all times Cavendish Homecare’s policies and procedures relating to the healthcare of those who use our services
report any change in the condition of a client immediately
co-operate and work with any treatment plans provided by specialist services
ensure that they have all necessary equipment and training in moving and handling in order to position and transfer the person safely in the home environment
always ensure that the dignity of people suffering from long-term conditions is maintained at all times

Care Plans for diabetic people must include details of exactly how episodes of hypoglycaemia should be managed. They should also include details of how the person should be managed if they are unwell and unable to eat.

For people with diabetes, monitoring blood glucose is important when unwell, as diabetes can have an additional effect on the illness and the illness can impact on their diabetes. Blood glucose can rise quickly during illness, particularly in older people who are dehydrated. Extra monitoring and medication, or adjustment to insulin doses may be prescribed, and additional support and monitoring needed.

Most people with diabetes take blood glucose levels at varying frequencies and equipment to do this may include Flash Glucose Monitoring or Freestyle Libre. The client should have their own blood glucose testing method and should be given support in conducting their tests at a frequency stated in their Care Plan. Blood glucose records must be maintained and the results of these should be monitored and regularly reviewed by nursing and medical staff.

People with type 1 diabetes can get the FreeStyle Libre free of charge on the NHS and those with type 2 diabetes if they suffer recurrent or severe hypoglycaemia or have impaired hypoglycaemia awareness.

People with diabetes should have a regular review of their medication and their dietary plan conducted by an appropriate person who is responsible for their care, usually their GP or a community nurse. The appropriateness of their Care Plan will be regularly reviewed by the Cavendish Homecare Nurse Manager, and reviewed in light of any major changes in the clients’ condition.

Diabetes Training

Cavendish Homecare believes that the education and training of staff in contemporary diabetic care is fundamental for the provision of high-quality care including the prevention of diabetic complications and early identification of complications.

Date: January 2024

Version: 2 (Review)

Source: Croner-i Ltd