Abstract
Institution: Russells’ Hall Hospital Dudley.
Introduction: Approximately 10-35% of inpatients suffer from diabetes. At least 10% of the emergency surgery population are diabetic, with the perioperative mortality for diabetes being up to 50% higher [1]. The prevalence of diabetes in the vascular surgery population is recognised, and a growing body of literature highlights poorer outcomes associated with hyperglycaemia.
This project examines the current practises around the perioperative management of diabetes in a vascular specialist centre in patients booked for emergency theatre.
Methods: From March 2020-2021 information was collected from bedside charts, drug charts, case notes and the electronic record. Data was collected on demographics, medications, specialist referral, insulin use, fasting times and capillary blood glucose (CBG) monitoring.
Five criteria were generated based on consensus, clinical judgement, and recommendations in the JBDS-IP guideline 2016 [2].
Results: 45 patients, age range 35-86. 82% had T2DM. 54% of all patients were on insulin, 24% on oral tablets and 22% on both. 26/45 patients missed one meal preoperatively, 18/45 missed 2 or more. Only 56% of patients had their medication managed appropriately. Basal insulin was missed in 44% of patients. 24% of medication errors led to adverse events for the patients. 8 patients in total were receiving intravenous insulin as a variable (n=7) or fixed rate (n=1) infusion. Of these 7/8 missed their basal insulin, and 4/8 were referred to the diabetes team. Monitoring errors occurred in 20% of patients, due to irregular CBG or ketone checks.
Conclusion: Current practises regarding diabetes management, particularly the omission of basal insulin, and monitoring are unsatisfactory.
Suggestions: A collaborative, multidisciplinary approach to the problem is likely to be most beneficial. Vascular, anaesthetic, diabetic and ward teams have been presented this data. Plans are being made for refresher sessions, aide memoirs, and reminders to upskill staff and improve the culture around diabetic management. A re-audit will be done in three months time.
References:
1. N Levy, N Penfold, K Dhatariya. BJA Education, vol 17, pages 129-135. Perioperative management of the patient with diabetes requiring emergency surgery.
2. Joint British Diabetes Societies - IP guideline 2016. Improving standards (diabetes.org.uk).
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