1911. Implementation of Diabetes Medication Management by Pharmacists in a Multidisciplinary Limb-Salvage Clinic
Session: Poster Abstract Session: Clinical Practice Issues: HIV, Sepsis, QI, Diagnosis
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • IDweekPoster1911.pdf (463.7 kB)
  • Background: Diabetic foot infections (DFIs) require complex medical care. At our hospital, a team of Infectious Disease (ID) specialists assess all inpatients with DFIs and transition these patients (pts) to an outpatient clinic with an ID and Podiatrist team. Clinical pharmacists have now joined the team to provide diabetes (DM) medication management. The goal of this project is to demonstrate the need for DM care in a multidisciplinary limb-salvage clinic.

    Methods: We performed a retrospective chart review of pts seen in the ID clinic Sept 2014- June 2015. DM medication management was implemented in Aug 2017. During clinic visits, the DM care plan is assessed for medication therapy problems related to indication, efficacy, safety and adherence for all new DFI pts. All findings and interventions are documented, discussed with the team and communicated to the pt’s primary care provider. Pts are followed at each visit to assess response to the intervention.

    Results: 500 pts were seen in ID clinic in 2014-2015. 123 pts had DFIs. 94 pts (76%) had uncontrolled DM defined as hemoglobin A1c (HbA1c) ≥7%. The mean baseline HbA1c was 10.13%. 50 pts (41%) had an amputation prior to the initial clinic visit. 69 pts (56%) were reevaluated in clinic for recurrent DFI after clinic discharge with a mean time to revisit of 210 days. 54% of these pts developed infections in the opposite foot. Post-implementation, 30 pts were seen by clinical pharmacists between Oct 12, 2017-April 26, 2018. All pts had uncontrolled DM with a mean baseline HbA1c of 9.85%. 20 pts (67%) had at least one amputation prior to the initial clinic visit. 28 pts (93%) had ≥1 medication therapy problem requiring pharmacist intervention. All patients required self-management education. There was a trend towards improved control of DM with an average HbA1c of 7.48% in the 13 pts returning for 3 month follow-up visits.

    Conclusion: All of our pts required pharmacist intervention to improve DM care. Incorporating DM management into the clinic visit was feasible and well received. A registered dietician has been added to the team to aid in DM management. We hypothesize that including DM management in a multidisciplinary approach to limb-salvage is an essential and effective way to manage DFI patients and may lead to reduced readmissions and amputations.

    Molly Rockstad, PharmD, BCPS, BCACP1, Tomasz Jurga, PharmD1, Sophia Choi, PA2 and Katayoun Rezai, MD2,3, (1)John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, (2)Ruth M. Rothstein CORE Center, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, (3)Rush University Medical Center, Chicago, IL

    Disclosures:

    M. Rockstad, None

    T. Jurga, None

    S. Choi, None

    K. Rezai, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.