In Slovakia, 197 686 diabetics were registered in 2018, in the age structure of 60 - 85+ years, defined as a vulnerable group in relation to the Coronavirus pandemic. He mentioned the main expert of MZ SR on diabetes, metabolism and nutrition disorders MUDr. Jaroslav Fábry, who informs about the functioning of diabetes clinics in the current situation.
The Diabetologist investigates patients in the standard office hours approved by the DPA for diabetes and provides telephone consultation. In particular, it provides urgent healthcare to the extent necessary and the health performance necessary to prevent the worsening of diabetes mellitus, within the current staff and material-technical options. Staff of the ambulance shall carry out work in available protective equipment. Diabetologist does not physically treat patients with stable diabetes, teaches them about self-monitoring of DM, the use of glucomers and glucose measurements in their social environment and manages patients' treatment through modern information and communication (mobile, SMS, e-mail, video talk, etc.) It uses e-Recipe and implements prescription drugs and medical devices for diabetics in sufficient quantity, at least and for a period of 3 months. In acute cases, after prior telephone consultation of the patient with a diabetic patient (before deciding to leave the house and go to the doctor), it is possible to arrange an examination in the diabetes clinic. If possible, the diabetesologist will only lock the waiting room and treat patients after prior telephone, SMS or email consultation. Repeated hypoglycaemic episodes, hyperglycaemic conditions with ketoacidosis, acute leg lesion (diabetic foot), intolerance, adverse reactions of the last ordinary treatment, treatment modification after hospitalisation, newly observed diabetes mellitus, technical problems with glucomer. In case patients come to the examination without prior telephone consultation, there must be a telephone number notice on the entrance door of the diabetes clinic in order to allow telephone consultation of the examination in the ambulance. It is appropriate that before the waiting room (but also on the website of the ambulance) it is clearly written on what t. No. the patient should call and consult his visit if he is standing before the waiting room. In case it is a patient without a mobile phone and therefore without the possibility of contacting a doctor before an ambulance, it is necessary to ensure that staff regularly check the waiting rooms (including the outside area). Patients' access to the premises of the ambulance is ideal for waiting rooms –. You or another close person have a positive travel history
Have you traveled abroad for the last 21 days? (All countries are considered risky countries).2. Were you or another close person in contact with a person with a confirmed coronavirus infection? 3. You or another person close to you in the ordered quarantine? (or government measures) 4. You have Are you or another close person to the symptoms of a respiratory infection?
If the answers to all the sorting questions are negative: The patient's Diabetologist investigates to the extent necessary. The patient can only enter the premises of the ambulance with barrier protection on the face (arm, in the last case scarf, etc.) The patient does not use a respirator with a vent in the examination. When entering the ambulance, the nurse invites the patient to see to it that his hands are thoroughly washed as instructed or that he applies alcohol disinfectant to the hands. In the examination of diabetics, the staff will use the barrier protection protective equipment recommended by the guidelines of the Slovak Public Health Office or by the standard procedure in the health care sector (COVID-19) in case of their current lack, they will use standard protective equipment according to the recommendations for minimum material and technical equipment of the Slovak Republic, which can be reinforced by the use of 2 masks at once, eye protection or one-off mantle. After examination, thorough surface disinfection is performed according to epidemiological guidelines. If the response to any of the sorting questions is positive:The Diabetologist in patients suspected of COVID-19 recommends that the patient be called 155 and the diabetes doctor himself calls the RÚVZ. In the absence of any protective measures, it is necessary to protect yourself as far as possible and to avoid physical contact with patients who might have transmission of infection. Ambulances, however, must continue to operate in an emergency mode, the availability of health care must be maintained by the presence of a diabetic patient in the ambulance, the availability for telephone consultation and patient guidance where necessary. In the case of KPRs, one set of protective equipment (at least one respirator or facial mask, gloves, glasses) is reserved for the patient in the practice. In case of representation of colleagues, it is necessary to include all health and patient data in the patient documentation and to write a short report on the telephone consultation/investigation and postpone it for inclusion in the documentation with the contractual provider of specialist outpatient healthcare. Provision of urgent healthcare to the extent necessary to prevent the disease from getting worse in relation to metabolic control of diabetes:Phase one: ambulatory care for patients on insulin pump therapy and patients on insulin therapy – intensified regimen and conventional regimen Organisational procedure:
- for 1 day up to a maximum of 15 patients - ordering patients to collect blood at a specified time (time area per patient 5 minutes or more)
- the nurse conducts sorting questions according to the methodical instruction by telephone when ordering the patient, makes a record and in case of negative questions the patient is ordered the following day for blood collection. The patient is admitted to the clinic on the specified day after measuring body temperature and after answering the question as to whether his health has changed since the previous day - the personnel carry out blood collection in accordance with strict principles of protection and disinfection - the patient must have a mask and gloves on the hands Second phase: decompensated patients on oral antidiabetic therapy evaluated on the basis of glycaemic profiles. The need to adjust for a new treatment. Diabetic patients on these treatments should have their HbA1c metabolic parameters checked. In case of prolonged patient retention in this form, it may result in the acute development of undesirable complications of diabetes. Given that it is the group of diabetics that is the second risk group of the Covidē19 pandemic, it is necessary to start providing gradual outpatient care for the proposed groups of diabetics.