Letter: Protocols and guidelines: a tool for insulin adjustment

I am writing in response to Katrina Woolley’s useful and informative article on clinical guidelines as a tool for insulin adjustment (Journal of Diabetes Nursing Vol 3, No 1: 26–30). She has put a huge amount of effort into researching the topic and as a discussion on the pros and cons of guidelines and protocols it was useful.

My concern arises when she asserts that ‘secure practice, professional accountability and ultimately the safeguarding of the patient and DSN is paramount’ but fails to make reference to the current DoH guidelines on group protocols (DoH, 1998). It could be argued that simple insulin adjustments do not require the group protocol treatment but then what do we mean by ‘simple’ and don’t patients often require more radical alterations that would be better covered by protocol? Crown 2(i) was intended to give us an interim structure for best practice and if we are concerned about safety we would be wise to follow the national guidelines.

Incidentally, since Katrina’s article went to press, the debate about protocols and guidelines has been widened by the publication of the final Crown 2 report which recommends that the practice of dependent prescribers should be informed by clinical guidelines. See page 37 for further discussion on the report.