893 Addressing the Potential Harms in Vascular Surgery Inpatients with Diabetes: A Double Audit and Intervention Project on HbA1c Monitoring and Diabetes Management

Aim Diabetes mellitus confers crucial prognostic consequences in vascular surgery patients. Derangements in long- and short-term glycaemic control predispose to increased risks of post-revascularisation amputation and overall cardiovascular morbidity and mortality. This project aims to address these potential risks by improving departmental HbA1c monitoring practice and diabetes management knowledge at a tertiary centre through a comprehensive educational intervention. Method A retrospective audit of HbA1c monitoring practice in vascular surgery admissions from August-September 2023 for peripheral arterial disease or diabetic foot infections was performed against a locally agreed guidance-based 3-monthly monitoring frequency. An educational audit on clinical staff’s knowledge of relevant practical and theoretical aspects to diabetes management was performed through a multiple-choice assessment. An educational teaching programme was subsequently designed and delivered. Post-intervention HbA1c monitoring was prospectively reassessed between October-November 2023, and a post-intervention knowledge assessment was performed. Results Mean pre-admission HbA1c values in the pre- and post-intervention admission cohorts were 78.6±18.4 mmol/mol (n=21) and 73.6±35.7 mmol/mol (n=12) respectively. Repeat HbA1cs were required in 38% of pre-intervention and 50% of post-intervention admissions. Appropriate HbA1c re-checks on indicated admissions increased from 25% to 86% post-intervention. Mean knowledge assessment performance increased from 56% to 77% with improved mean scores in all knowledge domains. Conclusions Gaps in departmental understanding of practical diabetes management and monitoring relevant to vascular surgery patients with diabetes were effectively addressed through the educational intervention. Referral practice for multidisciplinary diabetes optimisation and harm reduction should be a further area of focus given the patient cohort's highly elevated HbA1c measurements.