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Guide on delegating insulin management to HCAs


A new guide for managing insulin administration in the community, including safely delegating the task to non-registered staff, has been launched by Diabetes UK.

The two-part guide is aimed at helping community and district nurses, and diabetes specialist nurses to improve their caseload management and develop an insulin delegation programme.

“We know that this is an area where staff can often feel concerned about issues of accountability”

Helen Atkins

The first part of the guide, which was launched this week at the Diabetes UK Professional Conference in Glasgow, focuses on reviewing the community diabetes caseload.

It includes guidance on reviewing individual patients as well as the caseload as a whole to understand how care is being delivered.

It will support community teams to think about standards of care, staffing and caseload management processes, said the charity.

The second part focuses on developing an insulin delegation programme, where a nurse allocates the task of insulin administration to a non-registered practitioner, such as a healthcare assistant.

“Community nurses are likely to have a growing caseload of people who require support to manage their diabetes”

Simon O’Neill

The guide provides step-by-step guidance on developing the right policies and procedures, training and competency assessment, as well as clarifying the question of accountability.

Helen Atkins, a diabetes specialist nurse at University Hospital Leicester, who was part of the working group that developed the guide, said: “We know that this is an area where staff can often feel concerned about issues of accountability.

“This guide offers solutions to empower community staff to deliver care safely, by developing the knowledge and skills of community staff,” she said.

“There is huge potential to save time and money by ensuring the most effective use of staff time, and improve patient care delivery,” said Ms Atkins.

She added: “The guide gives them all the tools they need to develop an insulin delegation programme, from planning to preparing policies and procedures, checking competencies, designing and implementing training and evaluation.”

Simon O’Neill, director of Health Intelligence and Professional Liaison at Diabetes UK, said: “Community nurses are likely to have a growing caseload of people who require support to manage their diabetes, including being given insulin injections.

“It is therefore becoming increasingly important that more community staff are given the knowledge and skills to care for people with diabetes,” he said.

The guide, accredited by the Royal College of Nursing, TREND UK and the UK Clinical Pharmacy Association was developed in consultation with a working group of healthcare professionals with a special interest in this area.

It can be downloaded from the Diabetes UK website.


Readers' comments (11)

  • I think it's an insult to nurses that what is considered a two person check in hospital is a drug that HCAs can adminster in community.

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  • 55HCA

    I an a community Hca Band 3, who has supervised insulin administration for one dementia patient on our books for approx. 2yrs> I check his BM, and take any actions required if the reading is outside of normal range, put the needle on the pen, Tell the patient to dial up 42 units remind him to give the injection into the left or right side of his abdomen, The only thing I don't do is actually physically give the S/C injection. I also prompt his oral meds from a blister pack and give him two different eye drops into both eyes. Would it be such a large step if senior HCA's like me were actually authorised to do the whole job ?

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  • Rosemary Gondwe Mazhandu

    It is a good idea and saves alot on the workload of community nurses but the role of HCA should not be ignored as often you find that HCA who are given tasks which are supposed to be done by nurses refrain from doing tasks that they were employed for, such as tending to general hygiene, assisting in feeding etc. Nurses do some tasks that are done by Doctors but we don't stop doing what we are trained to do. I think there is need for job descriptions so that care is not missed but balanced.

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  • will the hca be prescribing insulin too?

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  • I remember in the old days when blood was only taken by Drs now we have phlebotamists, in the old days only Dr did suturing so what is the difference? I remember that families are taught to administer insulin to children or older family members. People with Personal health Budgets are getting Personal Assistants to leaen life saving techniques such as suction of tracheostomy, care of stomas and they have to be correctly trained and insured. Then why not for HCA as long as they have the necessary insurance for thing that can go wrong

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  • 55HCA

    Hospital Nurses take note: Hca's in DN team's rarely spend much time on personal care & feeding Its not that we don't like doing these tasks, but in the community the bulk of this fundamental care is done by Care workers employed by the social care sector, Hca.s in DN teams spend their time on giving care which includes wound care (not deep wounds or compression bandaging), venepuncture, pressure area care, catheter care, delivering equipment, prompting meds and instilling eye drops. and collecting specimens and swabs In short the work they do differs vastly from that which HCA's on hospital wards do,

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  • 55HCA

    PS you've got to be joking as far as I know, not even ANP's prescribe insulin yet !!

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  • We have recently asked our HCAs to help and prompt dementia patients in order that the patient can administer his own insulin which has been met with uncertainty and HCA's not feeling competent around this. No nurse, trained or what ever should be asked to undertake a procedure she does not feel fully competent in. I feel it's down to the DN's to train and explain or allow HCA's to attend an appropriate diabetic course before they are asked to carry out this procedure. They must understand what to do if the patient has certain side effects. After all the buck stops with the DN

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  • I used to work in Sweden as bank district nursing assistant, out of hours. I used to manage insulin dependant diabetics type 1/2 as prescribed per GP surgery. We were not allowed to do new patients or patients who's pglucous were unstable. We always had an experienced team leader(RN) incase we had queries. We also managed wounds, certain oral drugs, eye drops and other sc injections like daltaparin.

    In order to do this, you've to complete a diploma in HSC, similar to NVQ level 3, perhaps a bit more in depth. Omvårdnads Programmet if anyone is curious.

    It's a huge responsibility, and I don't think you should be doing a task unless you understand why you're doing it and how the body works.

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  • No place in the community for HCAs to be giving insulin. Why bother training at all? Always the unexpected with a diabetic.

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