Evidence-based diabetes management - implementation in residential aged care

Category: Personal, medical and clinical care

Vasey RSL Care, Vic.

Vasey House, Bundoora, Vic
ANZAC Hostel, Brighton, Vic
Sir William Hall Hostel, Ivanhoe, Vic
RSL Park Hostel, Frankston, Vic
Vasey Brighton East, Brighton East, Vic

Vasey RSL Care collaborated with a Diabetes Educator and has introduced standardised processes for blood glucose (BG) monitoring, response to measurements and care planning tools.

A comprehensive practice change program was implemented which included:

  • 315 staff (non-clinical, care and nursing) attended compulsory two-hour education sessions (2013-2014). These explained types of diabetes, risk factors, treatment, recognition and treatment of hypoglycaemia and performance of blood glucose monitoring. Sessions were delivered at each of Vasey RSL Care’s five homes on 19 occasions. 
  • In 2013-2014, 39 nursing staff participated in a workshop covering pathophysiology of diabetes, blood glucose monitoring, hypoglycaemia and hyperglycaemia, complications, sick day management; blood glucose lowering medications for Type 2; complications screening and minimising effects of such problems; encouraging healthy eating and physical activity; foot and skin care.
  • In 2014-2015, the Diabetes Educator conducted 13 training sessions attended by 190 personal care workers and enrolled nurses on ‘Care of resident with Diabetes’. This included performing blood glucose testing on residents, special foot considerations for those with diabetes, writing and reporting findings.
  • Diabetes assessment and foot assessment tools were developed. These are completed on admission and annually.
  • Development of BG monitoring flowcharts to support appropriate blood glucose monitoring regimens and direct nursing action in response to blood glucose measurement results. These incorporate the various regimens required for nursing action on days of illness and for both low and high BG results.
  • Replacement (at no cost) of the various blood glucose meters in use with a single meter that can test for ketones. Where required, residents are offered this meter.
  • Standardised hypoglycaemia treatment kits introduced. The kits include the laminated treatment flowchart and are kept in the blood glucose monitoring workstations. 
  • Procedures for insulin injections were reviewed and safety pen needle introduced to eliminate occupational exposure risk.
  • Development of a diabetes management procedure.
  • An audit to evidence improvements was developed and completed as baseline (one month after procedure publication) and rescheduled in accordance with initial results.
  • As the assessment tools and charting are now included in the computer software program, completion is monitored by clinical leaders. 
  • Case studies are presented at quality forums to discuss issues and build nurse confidence in the use of the procedure and flowcharts.
  • A practice-change memo was developed explaining the project objectives. This memo and the diabetes management documentation were provided to all nurses via the e-learning system. Medical practitioners were informed of the BG management flowcharts to be utilised by the nursing staff.


Staff knowledge of diabetes management has improved. Evaluation forms were distributed and collated for all training and workshops, with positive reports consistently obtained and respondents reporting significant increases in knowledge of diabetes management.

Diabetes and foot assessment tools have been completed with the 78 (100%) residents living with diabetes. They are asked about diabetes treatment goals, target BG levels, their wishes, comfort and quality of life. Thirty-one residents (40%) established their own treatment goals and target ranges. Where possible, residents monitor their own BGLs and administer insulin; currently three residents are doing this.

For more information on this program, contact Annette Greenwood, email: annette.greenwood@vaseyrslcare.org.au, or phone: (03) 9818 0568.