1911. Implementation of Diabetes Medication Management by Pharmacists in a Multidisciplinary Limb-Salvage Clinic

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 (patients) 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 patients seen in the ID clinic September 2014–June 2015. DM medication management was implemented in August 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 patients. All findings and interventions are documented, discussed with the team and communicated to the patient’s primary care provider. Patients are followed at each visit to assess response to the intervention. RESULTS: Five hundred patients were seen in ID clinic in 2014–2015. One hundred twenty-three patients had DFIs. Ninety-four patients (76%) had uncontrolled DM defined as hemoglobin A1c (HbA1c) ≥7%. The mean baseline HbA1c was 10.13%. Fifty patients (41%) had an amputation prior to the initial clinic visit. Sixty-nine patients (56%) were reevaluated in clinic for recurrent DFI after clinic discharge with a mean time to revisit of 210 days. 54% of these patients developed infections in the opposite foot. Post-implementation, 30 patients were seen by clinical pharmacists between October 12, 2017 and April 26, 2018. All patients had uncontrolled DM with a mean baseline HbA1c of 9.85%. 20 patients (67%) had at least one amputation prior to the initial clinic visit. Twenty-eight patients (93%) had ≥1 medication therapy problem requiring pharmacist intervention. All patients required self-management education. There was a trend toward improved control of DM with an average HbA1c of 7.48% in the 13 patients returning for 3-month follow-up visits. CONCLUSION: All of our patients 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. DISCLOSURES: All authors: No reported disclosures.