Preoperative Diabetic Management

6. PRE-ADMISSION CLINIC - PAC

6.1 The PAC is to ensure that patients are properly assessed and where possible, all investigations and treatments are carried out to enable day of surgery admittance.

6.2 Day only patients should only be seen in the PAC where there are medical or social reasons.

6.3 All the other patients should be seen at the PAC with a view to day of surgery admission.

6.4 The optimal time to be seen is 7-14 days prior to surgery to allow time for investigations and/or further consultation to take place.

6.5 The aim of the PAC is for "one stop shopping" so that all consultations and investigations can occur during the one visit. This is to include peri-operative assessment by an anaesthetist, admission by the surgical RMO, informed consent, discharge planning. Consultation with specialist clinical nurses, social workers and physiotherapists is to be arranged as required.

6.6 Investigations will be carried out only where indicated and in line with the Department of Anaesthesia policy for pre-anaesthetic investigation.

6.7 All investigation results must be reviewed by an anaesthetist or registered nurse from the Pre-Admission Clinic. Abnormal results are to be communicated to the relevant anaesthetist or to the surgical RMO. Results will be available in the notes on the day of admission.

6.8 The PAC should keep records and monitor results. These should form part of the Department of Anaesthesia records and be the basis of continuing research.

6.9 Guidelines for the management of diabetic patients in the Day Only and Peri-operative Ward.

6.9.1 Non insulin Dependent Patients

Omit oral hypoglycaemics on the morning of surgery. If prolonged fasting anticipated check BSL's 6 hourly. Glucose insulin infusion to be commenced in the operating theatre by the anaesthetist, if considered necessary.

6.9.2 Insulin Dependent Diabetics

Unstable patients or patients requiring prolonged preoperative fasting (e.g. for bowel prep) are not suitable for day admit for surgery.

Stable insulin dependent patients are to be scheduled first on the operating lists.

Morning patients omit their morning insulin. A glucose/insulin infusion is started in theatre if the patient is to be "nil-by-mouth" postoperatively or if the procedure is prolonged. The usual morning insulin is given with breakfast in the Day Only Ward, after the operation, if the procedure is short.

Afternoon patients will have breakfast and normal insulin at 0700 hours. They will have a 5% dextrose infusion commenced at 1100 by the surgical intern/RMO on arrival in the Peri-operative Ward. Further management will be arranged, as necessary, by the anaesthetist in theatre.