Patients with diabetes have complex medical needs, which are heightened
when faced with surgical intervention. St George's University Hospitals NHS
Foundation Trust introduced a diabetes specialist pharmacist to the preoperative
setting, in order to optimise and pre-empt medicines management
issues pre-surgery, and to collaborate and better utilise skill sets of other
healthcare professionals. From pre-operative care to theatres, recovery, ward
and finally discharge, pharmacists ensured bespoke plans were actioned and communicated, with excellent
feedback from surgeons, anaesthetists and diabetes team. Since completion of this work, the data has been fed
back to the Trust chief executive with the creation of permanent pharmacist support. There has since been a drive
to upskill pharmacy workforce through specialist diabetes workshops and simulation projects to support patients.
Diabetes is one of the most common chronic disorders, affecting at least 6% of people in the UK with
the prevalence rising. Patients with diabetes have complex medical needs, but often overlooked are
the increased risk of surgical interventions in this group due to diabetes related co-morbidities. As a
result at least 10% of patients undergoing surgery will have diabetes and in some hospitals as many
as 30%. Failure to identify patients before admission increases the risk of errors. Service provision
delivered to the elective surgical diabetes patient did not separate and highlight their specific needs
or recognise numerous benefits diabetes patients would receive from dedicated input.
These were numerous, and included 100% of peri-operative management plans to be created and implemented
with active patient participation, preventative screening and meal plan to reduce fasting period and requirement
for intravenous insulin. Also, to highlight and manage patients with poor glycaemic control and encouraging
patients to self-manage confidently by promoting patient ownership and control. Other aims included
preventing cancellations, reducing delayed discharges from hospital and reducing overall length of stay.
Back to the top