None listed
Conditions
Brief summary
Background: The perioperative management of inpatients with diabetes is complex given carbohydrate intake and diabetes medication administration is altered. Suboptimal glycaemia in the perioperative period is well documented in the literature and is associated with increased morbidity and mortality. Aim: This study has been undertaken to determine the effect of a structured perioperative diabetes management plan (PDMP) on the appropriate recommendation, prescription, and administration of diabetes medications in the perioperative setting. A multidisciplinary team developed a novel structured PDMP endorsed by the Departments of Diabetes & Endocrinology and Pain & Anaesthesia. This observational study consisted of pre- and post-intervention periods, where pre-intervention care for perioperative diabetes management (non-structured) was audited for 4 months in 2016 and then re-audited for 4 months post-intervention in 2017 (structured plan). The primary outcome measure was documentation of appropriate recommendation, prescription and administration of diabetes medications in the perioperative setting according to the PDMP. Secondary outcome measures included glucose monitoring practice and glycaemic measures.
Interventions
A new structured perioperative diabetes management plan (PDMP)
A single double-sided A4 sheet.
The front page outlines the details of the surgery, a brief summary of the patient's diabetes history, and the regular diabetes medications taken by the patient at the time of the preadmission clinic appointment. It also includes the plan for any changes to these regular medications prior to the surgical procedure, including instructions regarding changes prior to the day of the surgery, on the day
A new structured perioperative diabetes management plan (PDMP) A single double-sided A4 sheet. The front page outlines the details of the surgery, a brief summary of the patient's diabetes history, and the regular diabetes medications taken by the patient at the time of the preadmission clinic appointment. It also includes the plan for any changes to these regular medications prior to the surgical procedure, including instructions regarding changes prior to the day of the surgery, on the day of surgery, and in the post-procedure recovery period. Instructions regarding glucose monitoring and dextrose use are also outlined on the front page of this plan. The back page has the details of the recommendations for changes to the various diabetes medications in the perioperative setting. It divides these medications into insulin and non-insulin groups and provides recommendations according to the likely time of procedure (AM vs PM). It also provides details of blood glucose values to be aimed at achieving and maintaining, and methods of correcting any abnormalities in blood glucose levels. This PDMP is to be filled out by a doctor, either a Hospital Medical Officer or Anaesthetist, during an appointment at the Preadmission Clinic, which occurs prior to the day of surgery. The relevant details of the PDMP are communicated to the patient during their appointment at the Preadmission Clinic, but the method of communicating this information is left at the discretion of the doctor (photocopy of the plan given to patient, verbal communication, details written on separate document and given to patient). The PDMP itself is kept with the other appointment documents, to be used during the admission.
Sponsors
Royal Melbourne Hospital - City Campus
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients with known diabetes that attended an appointment at the Preadmission Clinic 3East at the Royal Melbourne Hospital. Elective surgery
Exclusion criteria
Patients who were diet controlled. Patients who did not have a medication chart completed - unable to determine if medications were appropriately prescribed and administered. Patients with incomplete documentation on the electronic medical record. Patients who underwent emergency surgery. Patients who underwent cardiac surgery - seen in a separate clinic and subject to different guidelines
Outcome results
None listed