CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME
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1 CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME 1. Aim/Purpose of this Guideline This guideline is for the management of Adult patients with Diabetes Mellitus diagnosed with Acute Coronary Syndrome (ACS) and hyperglycaemia. It has been benchmarked against national guidance, to provide detailed guidance on the clinical management of Diabetes during surgery in line with best practice guidelines. 2. The Guidance ACS encompasses a spectrum of unstable coronary artery disease, ranging from unstable angina to transmural myocardial infarction. Hyperglycaemia is common in people admitted to hospital with ACS, and has been shown to be associated with increased in-hospital mortality. Known diagnosis of diabetes prior to admission Diagnosis of Acute Coronary Syndrome diagnosis of diabetes prior to admission t appropriate to follow this guideline, gain senior medical review Check most HbA1C. Repeat HbA1C if not recorded within the previous 3 months Continue with current diabetes medication and Monitor peripheral blood glucose 4 x daily If peripheral blood glucose > 11 mmol/l for 3 readings The Peripheral glucose > 11 mmol/l Check HbA1C and Random Venous Glucose HbA1C > 48 mmol/mol refer to diagnosis of diabetes guideline Diagnosis of Diabetes? Titrate current diabetes medication Monitor peripheral blood glucose 4 x daily If peripheral blood glucose remains > 11 mmol/l for 3 readings despite titration of current diabetes medication Monitor peripheral blood glucose pre and 2 hourly post meals x 3 If peripheral blood glucose > 11 mmol/l for 3 readings, advise GP on discharge letter to offer fasting glucose at 6 weeks and annual HbA1C Refer for Diabetes Review: Diabetes In-Patient Specialist Nurse ext 3104 / bleep 2205 and/or the Endocrine Team Page 1 of 6
2 Guidance tes Metformin Guidance Metformin Tablets, should be discontinued if ejection fraction is < 35 %, and prior to any investigation / procedure requiring iodinated contrast and/or general anaesthesia. It should not be recommenced until at least 48 hours after procedure and/or general anaesthesia. U & E s should be checked prior to recommencing. Pioglitazone Guidance Patients taking Pioglitazone should have medial review for signs of heart failure / fluid retention 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Compliance with the relevant process (A-F above) for patients seen at a Diabetes Team Review. Specialist Adult In-Patient Diabetes Team Patient Documentation Adult in-patients with diabetes who have hyperglycaemia and Acute Coronary Syndrome and who are reviewed by the specialist diabetes team n compliance will be reported to the responsible medical team, ward /area manager. n compliance resulting in an adverse patient event will be reported via Datix Medical teams / ward / area managers will undertake subsequent recommendations and action planning for any or all deficiencies and recommendations within reasonable timeframes for their areas The Specialist Adult In-Patient Diabetes Team will undertake any trust wide recommendations and action planning for any or all deficiencies and recommendations within reasonable timeframes Change in practice and lessons to be shared Lesson learned or changes to practice will be shared with all the relevant stakeholders 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 2 of 6
3 Appendix 1. Governance Information Document Title Clinical Guideline for the management of Hyperglycaemia in adults with Acute Coronary Syndrome Date Issued/Approved: Date Valid From: Date Valid To: April 2017 Directorate / Department responsible (author/owner): Contact details: Medical Directorate Amanda Veall Lead Clinical Nurse Specialist Diabetes Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Clinical Guideline for the management of Hyperglycaemia in adults with Acute Coronary Syndrome Diabetes, Surgery, Hyperglycaemia, Acute Coronary Syndrome RCHT PCH CFT KCCG Medical Director New document New document Diabetes In-Patient Specialist Nurses, Consultant Endocrinologists, Consultant Cardiologist Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Page 3 of 6 t Required {Original Copy Signed} Internet & Intranet Diabetes Cardiology Intranet Only Links to key external standards DoH:NSF Diabetes 2001 standard 8 Related Documents: 1. NICE (2011) Hyperglycaemia in acute coronary syndrome
4 2.. British National Formulary March 2014 Training Need Identified? Version Control Table Date Version 2014 V1.0 Initial Issue Summary of Changes Changes Made by (Name and Job Title) Amanda Veall CNS Diabetes All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager Page 4 of 6
5 Appendix 2.Initial Equality Impact Assessment Screening Form CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME Directorate and service area: Medicine Is this a new or existing Policy? New Policy Name of individual completing assessment: Amanda Veall 1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at? Telephone: To provide detailed guidance on the clinical management of adults with hyperglycaemia in acute coronary syndrome 2. Policy Objectives* To provide a consistent approach to the management of hyperglycaemia in acute coronary syndrome within RCH sites. To maintain patient safety and improve outcomes for adults with hyperglycaemia in acute coronary syndrome 3. Policy intended Outcomes* 4. *How will you measure the outcome? 5. Who is intended to benefit from the policy? 6a) Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b) If yes, have these *groups been consulted? C). Please list any groups who have been consulted about this procedure. Consistent management of hyperglycaemia in acute coronary syndrome at RCHT sites. Prompt and safe management of hyperglycaemia in acute coronary syndrome Audit Datix Reporting Review of medical/ nursing documentation as required All adult patients with hyperglycaemia in acute coronary syndrome. Diabetes Inpatient Specialist Nurses Consultant Endocrinologists Consultant Cardiolgist 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Rationale for Assessment / Existing Evidence Age Page 5 of 6
6 Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - Learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked in any column above and consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Amanda Veall Date Page 6 of 6
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