Introduction: Early identification of poorly controlled diabetes prior to booked hospital admission for surgery and procedures provides the opportunity to improve glycaemic control to reduce complications and improve outcomes while enhancing the care of patients with diabetes. The role of the Nurse Practitioner in Diabetes provides timely access to treatment in this at risk population providing education as well as prescribing appropriate medications.
Aims: In January 2014 the role of the Nurse Practitioner in Diabetes extended to include pre admission clinic referrals of patients with an HbA1c ≥ 9% (75 mmol/mol). The aim was to intervene and improve glycaemic control prior to surgery. 26 referrals were received between January to June 2014. Data was collected on current diabetes treatment and complications as well as interventions made by the Nurse Practitioner.
Outcomes: Interventions included general diabetes education, commencing home blood glucose monitoring, adjusting diabetes medications and commencing insulin treatment. Insulin therapy was commenced or adjusted in 7 patients and 2 patients who required additional medications declined. HBGM was commenced in 5 patients, 5 patients were not contactable prior to surgery; the remaining patients received advice on diet and monitoring. Limitations for timely intervention were related to a delay in referral to the Nurse Practitioner either because Point of Care HbA1c was not attended in pre admission clinic and referral was initiated after formal results reviewed, or the short timeframe from referral to date of surgery. Hospital outcomes will be evaluated in the future.
Recommendations: Pre admission diabetes management by a Nurse Practitioner CDE provides the opportunity for autonomous care at the time of presentation. Improving pre-operative glycaemic control requires timely referral to diabetes services.