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Video conferencing applications to establish a distributed educational network: enhancing early referral of those with acute diabetic foot
Authors: Alexandra Jones
Sandra MacRury
Fiona Fraser
Annette Thain (NES)
Institutions: NHS Highland - Diabetes Podiatry - Wick - United Kingdom,
NHS Highland - Diabetes - Inverness - United Kingdom
NHSEducation for Scotland - RRHEAL - Inverness - United Kingdom

Diabetes Foot Education Network

  • NHS Highland evidence based clinical guidelines management of the foot in diabetes (developed 2013)
  • Need to increase Healthcare Professional (HCP) familiarly and application of guidelines
  • The Scottish Diabetes Improvement Plan 2014 pledges to ensure delivery of consistent, high quality diabetes education
  • Early referral to reduce amputation rates

Purpose of DFEN

  • Increase awareness and application of existing local & national guidelines
  • Provide facilitated specialist education
  • Provide opportunity for at distance staff networking and sharing best practice
  • Promote and increase rates of early referral




Summary of Work

Delivery Plan

  • Lead diabetes clinicians collaborated with Remote & Rural Health (RRHEAL) and NHS Education Scotland (NES) to increase educational reach and resulting clinical application
  • Video Conferencing (VC)  was an accessible medium to enhance networked mixed discipline engagement
  • Expert knowledge existed within the team to deliver  open, case based approaches across an annual programme supporting critical discussion
  • Presentations are person focused, guideline specific, educational and instructive in terms of guideline application                                    


Summary of Results





Take-home Messages
  • This work delivers an educational intervention that is cost neutral, accessible and inclusive for staff by geography and profession
  • Enhances knowledge and application of guidance for early referral
  • Offers the  opportunity to network and engage at distance
  • Connection between remote practitioners and the Specialist hub, enhancing communication and clinical practice or application
  • Knowledge support enhances retrieval & application of evidence based guidelines to the benefit of staff teams and, ultimately, the diabetes population

NHS Highland is a region of Scotland covering 32,500 square kilometres (12,500 sq mi).  There is a diabetes population equalling 16,207 (Scottish Diabetes Survey 2014)(1.3 diabetes patients per square mile!). It employs approximately 10,500 staff.

The Diabetes Action Plan 2010: Quality Care for Diabetes in Scotland was centered around  principles of the Quality Strategy and was intended to drive up standards of care through genuine involvement of people with diabetes, sharing of outcome information and the promulgation of best practice. The 2014 Diabetes Improvement Plan builds on progress to date, describes priority areas for improvement and outlines expectations in the context of new approaches to quality improvement.

Supporting and Developing Staff is just one of those priorities, to ensure healthcare professionals caring for people living with diabetes have access to consistent, high quality diabetes education to equip them with the knowledge, skills and confidence to deliver safe and effective diabetes care.


Summary of Work

The clinical authors of this poster have an educational remit within their respective job plans.  Referring again to the area of NHS Highland, and that the lead clinicians are based 110miles apart, using video-conferencing is a routine part of communication.  Engaging with NHS Education Scotland (NES) delivered knowledge on how to develop our Diabetes Foot Education Network. The Knowledge Network provides additional resources once we have decide which topic will be covered; a document is produced detailing appropriate reading material, evidence and recent papers.

On the day we have had up to 10 VC sites engaging.  We have set a limit of 10 sites to ensure control and maximisation of discussion.  It is necessary to have excellent facilitation skills to allow this to happen. The clinical authors of this document were already skilled facilitators; we have identified others, attending on Network days, who have an interest in developing facilitation skills.  Once these individuals are trained pressure will be relieved on current presenters.

We include speakers from the wider diabetes team since further topics requested from delegates include:

  • Foot screening update; identifying foot risk, screening tools
  • Diabetes/non-medical  prescribing
  • Diabetes health promotion, Patient motivation
  • ABPI + TPI measuring
  • Vascular issues
  • Dietician input
  • Tissue viability team input
  • Microbiology
  • General diabetes management
  • Comparison of diabetes foot ulcers/ diabetes foot ulcer classification
  • Surgery for the diabetic foot
  • Psychology Footwear issues - how to offload effectively
Summary of Results

The specialist team have delivered four sessions to date.  Feedback from healthcare professionals attending has been very favourable.  Everyone has improved their knowledge.  Comments concerning the value of networking have included :

  • Promoting MD working is essential for the care of the diabetic foot.
  • Different professionals can learn what each other is doing and ask questions to people more skilled in a field
  • It's good to put a face to the name and seems to make working in a remote and rural region much easier.
  • Was able to hear from a GP which is good as both being health professionals outside the Hospital setting means we sometimes have similar difficulties in getting services quickly.
  • 100% of value

Previously mentioned in this presentation has been the area of NHS Highland.  Trying to deliver learning/training/education is not without it's challenges.  This is where video conferencing (VC)  has a place.  Using VC is also not without it's challenges and sesions have not always run smoothly for us.  However, feedback from those attending sessions says:

  • VC is not everyone's preferred medium but we have to utilise speakers' time
  • It is not practical for staff to travel great distances to all educational events;VC helps us overcome this.
  • Appropriately developing people to take on VC facilitation skills instead of depending on speakers to lead the facilitation
  • More appropriate seating arrangements.  At the main site people had their backs to the screen.
  • Too much echo.
  • Good attendance, hopefully will increase as time goes on and more professions join in.
  • Really enjoying the sessions and the fact I don't have to travel 180 mile round trip to hear lectures - VC is great when it works but sometimes it is a hit and a miss up here and blame internet connection etc.

Some VC units are hosted and owned by general practice, others are hosted within NHS facilities and maintained by e-Health.  DFEN organisers liaise with e-Health where issues are reported from each event.


Take-home Messages
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