Search

Patients with diabetes are at increased risk of drug errors and medication interactions. Pathways should ensure medication reconciliation is performed, as this is vital to these at risk patients. ²⁶⁹ Insulin errors including overdoses occurring due to abbreviations or use of incorrect devices are classed as a never event by NHS Improvements.^271,272

Consideration should be given to scheduling patients with diabetes at the start of the operating list, to minimise disruption to the patient’s glycaemic control.

Hospitals should provide the services and resources required for the management of the surgical patient with diabetes, including explicit managerial and clinical policies.^33,269,270

Hospitals should consider appointing a lead anaesthetist for diabetes with appropriate time for the role identified in their job plan.²⁷⁰

Hospitals should have clinical guidelines, including:³⁴

involving patients in the management of their own diabetes

• ensuring that surgical patients with diabetes have an individualised explicit plan for the management their diabetes during periods of starvation and surgical stress; this may require the involvement of senior anaesthetic staff and the availability of equipment to continue or institute variable rate intravenous...

In patients with learning disabilities or special needs, there should be close co-operation with other specialists. A learning disability liaison nurse could be available to support patients and carers while attending the hospital either for outpatients, day surgery or as inpatients. If patients lack capacity and are unaccompanied, then the involvement of an independent mental capacity advocate (IMCA) should be...

Departments should have a policy on how to care for patients with additional needs including those covered under the Equality Act, and consider appointing an assigned lead anaesthetist with time in their job plan for the role.^274,275 The policy should incorporate preassessment, deprivation of liberty assessment, consent, pathways to minimise anxiety and considerations for analgesia and discharge planning.²⁸¹

Some patients who are unable to leave their homes and have difficulty in accessing primary or secondary care may benefit from a home visit for their preoperative assessment and preparation. The same may apply to prisoners detained in HM Prison Service.

Translators or interpreters should be available for patients who do not speak or understand English and those who use sign language. Written information also needs to be available in different languages.

Training of anaesthetists includes attaining the competency to perform medical assessment of patients prior to anaesthesia and surgery or other procedures.276