Authors (including presenting author) :
LAM YH(1), LAU SLT(1),LAU YFE(1),HUANG HY(1),PANG HK(1),Wat ZMW(1),LEE HYH(1), HUE SM(1),CHUNG CT(1), LEE CN(2), LEUNG WL(2), YIP MY(2), YOUNG R(3)
Affiliation :
(1)Diabetic Ambulatory Center, Department of Medicine, Pamela Youde Nethersole Eastern Hospital(PYNEH), (2)Department of Obstetrics & Gynecology,PYNEH, (3)Department of Dietetics,PYNEH
Introduction :
The prevalence of diabetes in pregnancy has increased worldwide. There are potential serious maternal and fetal complications. The occurrence of gestational diabetes (GDM) and undiagnosed diabetes in pregnancy have increased due to the implementation of international standard screening at 26th-28th maternity weeks. In view of the huge demand for improving maternal care, collaboration of Endocrinologists, Diabetes Nurses and Obstetricians will prove the best utilization of resources. In additional to our usual practice with the delivery of GDM talks and referrals to the Endocrine team, service improvement goal is to provide a structural workflow according to a systematic caring model, with the involvement of multidisciplinary teams, to meet international standard for pregnant women with diabetes and GDM during pregnancy.
Objectives :
To organize structural workflow for women with diabetes and GDM during their pregnancy. To maintain the standard maternal diabetic care while facing increased workload. To minimize the risk of adverse pregnancy outcomes in both fetus and mother.
Methodology :
A meeting with the Endocrine team and the Department of Obstetrics & Gynecology was held in November 2017. A consensus on workflow improvement of pregnant women was made to meet international standard of target glycemic control. Endocrinologists referred diabetic pregnant ladies to diabetes nurse for education and fundoscopy. These ladies are requested to phone report their home blood glucose results weekly. A new documentation record was in place: a form with haemoglucostix readings and another summary table with all the necessary information to facilitate case discussion at the weekly Endocrine Round. A referral channel for urgent consultation was set up for those who need early attention and closer monitoring.
Result & Outcome :
Diabetes nurses give immediate advice to all pregnant women who required close monitoring after their phone report. Those with suboptimal glycemic profile are discussed at the Endocrine grand round with adjustment of medication or insulin dosage, or advancement of follow up consultation. This systematic caring model was effective to meet international glycemic standard without causing significant hypoglycemia. It provides quality care to pregnant women with diabetes by collaboration and close communication among health care professionals and enhanced staffs satisfaction.
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