45-year-old man planned for cystoscopy and retrograde pyelogram

Background

• IDDM – Type 1
• ESRF – haemodialysis
• Uncontrolled hypertension
• Cognitive decline – multiple CVA’s
• BKA 2018

Issues

• Cancelled on day of surgery – BSL = 27mmol/L
• Regular insulin and antihypertensives had been withheld on morning of surgery

Discussion

Could this have been prevented?

• Phone consult undertaken – difficult due to cognitive decline
• Webster pack reviewed and medications charted accurately
• Insulin not documented on webster pack form and missed
• Phone call from day stay to patient the night before. Patient asked about insulin, told towithhold as nothing documented in notes
• Very easy mistake to make during difficult phone consult
• Need to check separately for injectable medications, inhalers, anticoagulants, and aspirin
• Prolia (denosumab) commonly forgotten by patients as is 6-monthly injection.
• Perioperative management of medication guidelines www.perioptalk.org
• If in doubt about perioperative medication, can discuss with prescriber