Abstract
Introduction
Diabetes is prevalent (15%) in patients undergoing hip fracture surgery, with inadequate perioperative management linked to poor outcomes. National guidelines recommend surgical prioritisation, medication management, strict glycaemic and electrolyte monitoring, yet adherence remains suboptimal. This audit assessed compliance with the Centre for Peri-Operative Care standards at Ealing Hospital.
Method
A six-month retrospective audit (Aug 2024 – Jan 2025) reviewed the perioperative care of 26 diabetic patients (28% of 94 total hip fracture cases). Data were collected using online patient records. Key areas assessed included prioritisation in the theatre list, appropriate diabetic medication and insulin management, capillary blood glucose (CBG) and electrolyte monitoring, and variable rate insulin infusion (VRIII) initiation.
Results
Only 57% of diabetic hip fracture patients were prioritised in theatre lists. Target CBG (6-10 mmol/L) was only achieved in 50%. Inconsistent perioperative diabetes medication adjustments were noted, including inappropriate metformin and insulin withholding. Electrolyte monitoring compliance was low (42%), particularly among chronic kidney disease patients (70% non-compliance). VRIII was underutilised, with 42% of patients not receiving it despite missing more than one meal or persistent hyperglycaemia (CBG > 12).
Conclusion
This audit highlights significant gaps in perioperative diabetes management in hip fracture patients. Adherence to national guidelines was suboptimal, particularly in medication management, VRIII initiation, and electrolyte monitoring. To improve care, we propose staff education and a succinct summary of the national guidelines in the trust’s online guideline bank, accessible to all healthcare staff. A re-audit in 2025 will assess the impact of these interventions.