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.
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