Lisa Moore, Operational Lead for Long Term Conditions and Diabetes Specialist Nurse, conducted a Quality Improvement (QI) project aimed to empower patients to manage their diabetes independently whilst reducing the number of home visits for insulin administration by the Havering district nursing service.  

The team was facing an increasing number of home visits for insulin administration due to a growing caseload of patients requiring support to manage their diabetes. This demand created a considerable challenge to capacity of the service to meet patient needs. 

Lisa aimed to increase patients who manage their diabetes and thereby reduce the number of visits by the Havering district nursing service for insulin administration by 10% by November 18, 2025. 

How did she do it? 

Lisa undertook a patient questionnaire to assess how patients felt about being more independent with their diabetes and insulin management. She employed a dedicated Diabetes Specialist Nurse (DSN) to review all patients on the district nursing caseload. The DSN started working with the Trust in November 2024 and provided education and support to improve patients' skills and knowledge in managing diabetes. 

Results and patient stories 

As a result of this change idea, in the first five months: 

• 9 clients have been taken off insulin
• 9 clients have had their insulin visits reduced from twice to once daily
• 1 client has had their visits increased from once to twice daily
• 8 clients have been taught to self-administer insulin
• 13 clients have been started on isCGM
• DN visits have been reduced from on average 100 daily visits to 84 daily visits 

The success of the project is best illustrated through the experiences of individual patients: 

End-of-Life Patient: A patient nearing end of life wished to continue insulin to relieve hyperglycaemia symptoms. Within an hour of a DSN visit, insulin injections were reduced and isCGM was introduced to avoid painful finger pricks. The following week, the patient was more engaged and comfortable, and their family expressed relief at the improved quality of care. 

Young Patient with Down Syndrome and Autism: Living in a specialist residential home, this patient was receiving four insulin injections and three fingerstick tests daily. The DSN introduced a new insulin regimen and switched to Dexcom One+ for glucose monitoring. Within two weeks, average glucose levels dropped from 16.0 to 9.5 mmol/L. The patient became more engaged to receiving care, and the simplified treatment reduced stress and discomfort for both the patient and caregivers. 

Visually Impaired Patient: Initially uncomfortable with injections and unable to self-manage, this tech-savvy patient was supported to try oral medication and Dexcom One+ for glucose monitoring. The device provided audible readings via smartphone, enabling the patient to stop insulin and gain independence. Both the patient and their next of kin expressed joy at the autonomy and confidence. 

What’s next? 

The project will continue through November 2025, with plans to review all current and new patients on the caseload. The dedicated DSN will keep working across Havering to provide education and support, aiming to further reduce dependency on home visits and enhance patient empowerment. We hope that this learning can be shared and scaled across other similar services through testing and adapting in their local systems at place. 

Lisa’s initiative not only reduced the number of home visits but also transformed lives by giving patients greater control over their health. 

For more information on this great piece of work, please see Lisa’s project poster: https://www.nelft.nhs.uk/download/lisa-moorepdf.pdf?ver=34709&doc=docm93jijm4n22218.pdf  

If you would like to conduct your own QI project like Lisa, we are starting our next cohort of Facilitator training: Quality Improvement Facilitator Course | NELFT NHS Foundation Trust