Endocrinology Unit
Operational Policy 2003
Part 1
Operational Policy for Diabetes:
There is no disease in the pediatric age group that
needs the amount patient education than diabetes. To achieve the
therapeutic goals, of a normal healthy child, extensive and continuous
education should target both parents as well as the child. This is the
main aim of the diabetic unit in Farwania hospital.
Mission:
* Provide the initial
and ongoing care for the diabetic children and their caregivers.
*
Establishing standard protocols for management of diabetes for general
pediatricians.
* Provide education for the schools.
Vision:
* Maintaining normal growth and
development of diabetic children.
* Preventing acute complications
*
Preventing long-term complications.
* Maintaining normal every-day
activities, specially school.
* Give the child/parents enough knowledge
and skills to be confident in managing his day-to-day problems related to
diabetes.
Structure:
1.
Bed
Allocation* The diabetes unit is part of the pediatric department
of the hospital.
* The patients are admitted in the pediatric wards (5
and 7), which are located in the ground floor of Farwania
Hospital.
2.
The Diabetes
teamThe diabetic team includes the
following members:
* Dr. Majedah Abdul-Rasoul
Pediatric Endocrinology Specialist,"Head of the
Unit"
* Dr. Hessa Habib
Senior Registrar
*
Dr. Maha Alkholy
Registrar
* Mrs Salwa Al-Ostath
Dietician
* Mrs Olfat Shawqi
* Mrs Layla Ali
Diabetes Foot
Clinic
* Mrs Rana Khalid, Zainab Hussein
Child life
Team
* Mrs Hanan Al-Adwani
Social
Worker
The head of the department is
responsible for:* The development and implementation of
the operational policy
* The development of guidelines for the
treatment of diabetes in children in its various forms ( appendix ).
*
The development of the different formats used in the outpatient for
patients with diabetes (appendix )
* Continuous review and monitoring
of the quality of care provided for the patients and their families.
*
The orientation and continuous education of the members of the
department.
* Recommendation to the department council and other
organizations for the needs of the unit; including equipments like
glucometers, staff like dietitian and nurse educator and more rooms for
the outpatient clinics.
Function of
the unit:Referral Policy To The Unit:The
unit is a sub-specialty unit so, patients are seen by referral.
Urgent
cases are seen without referral.
Referrals are made from the
polyclinics and the primary health clinics to the unit.
The majority
of the patients are from the residential areas that belong to the
hospital, however some are seen from outside the area because not all the
hospitals have pediatric diabetic units.
Referrals are also made from
the general pediatric department of the hospital, some are referred from
the internal medicine department for outpatient follow up; those aged
12-18.
In-Patient Policy Of The Unit:All
patients are admitted to the hospital at diagnosis for about 4-7
days.
The nature of the immediate management depends on the patient’s
condition.
Patients with ketoacidosis are started on intravenous
therapy, while patients with hyperglycemia can be started on sub-cutaneous
insulin.
Parents are given the support to overcome the initial grieve
following the diagnosis
Education program is usually started after the
acute phase of the disease is managed.
Educational/Teaching Program for
newly diagnosed patients with diabetes (see accompanied
appendix):
i. The program is done over 5
days, and stared with at least one member of the family plus the child, or
2 members if the child is less than 6 years of
age.
ii. The speed of education depends on the
parents and the child.
iii. Families are given
choices about the different glucometers available in the markets, for them
to decide which one to get.
iv. They are then
taught on the machine they get to avoid
confusion.
Discharge
Plan: i. Patients are provided with a
contact number of one of the team members for emotional support and
day-to-day problem management
ii. Parents are
given written instruction to be delivered to their school, with
instructions on how to handle acute emergencies like
hypoglycemia.
Follow up
Plan: i. All newly diagnosed patients
are seen weekly, for further education and insulin dose adjustment. The
weekly follow up is done in the meeting room of ward
5.
ii. Patients are then seen twice a month
until the education plan is in forced completely, after which they are
seen every 2 months in the outpatient.
Out-Patient
PolicyThe outpatient is organized as
follows:
1. Saturday: Dr Majedah Abdul-Rasoul
(Patients seenweekly)
2. Monday: Hessa/Dr. Maha
(Patients seen weekly)
3. Tuesday: Dr. Majedah , Dr.
Maha (Room 2)
Dr. Hessa (Room
1)
Mrs Salwa: Dietician (Room
5)
4. Wednesday: Dr. Majedah, Jahra
Hospital
On-Call Schedule:Dr. Majedah and
Dr. Hessa are on-call for 24-hours on alternate days. They are consulted
on every diabetic patient admitted to the hospital.
Patients themselves
can contact the treating physician from the unit any time of the day
(24hrs).
___________________________________________________
Part 2:
Operational Policy for Endocrine
The division of
endocrine covers all areas in pediatric endocrinology including disorders
of growth, puberty, sex differentiation, glucose metabolism, calcium and
bone disorders, the pituitary and hypothalamus, the thyroid, the adrenals,
and the gonads.
Mission:
Provide care for patients with all endocrine
disorders in term of diagnosis and treatment.
Perform all dynamic tests
necessary for the diagnosis of endocrine diseases.
Establish standard
protocols for the investigations and management of these endocrine
diseases.
Training general pediatricians for the different aspects of
managing pediatric endocrine disorders.
Vision:
Management of all above mentioned endocrine
disorders and minimizing complications of the different therapeutic
modalities.
Maintaining normal growth (height potential) of the
patients with endocrine disorders.
Educating parents/patients about
the nature of their disorders to be able to achieve the maximum benefit of
the therapy and meet their goals and expectations.
Avoid unnecessary
investigation of patients with short stature by providing appropriate
explanations and education for the patients and their parents, and by
regular follow-up.
Structure of the Unit1. Bed
Allocation
The patients are admitted to the pediatric wards, if they
need in-patient care. Otherwise, they are cared for in the
outpatient.
2. The Endocrine Team:
* Consultants
Dr. Majedah
Abdul-Rasoul
* Senior Resistrar Dr. Hessa Habib
*
Registrar
Dr. Maha
Al-Kholy
Function of the UnitPatients are
referred to the unit from the pediatric and neonatal outpatients in the
hospital, polyclinics, and from others government and private
hospitals.
Inpatient Policy* In-patient Care is
provided for:
i. Dynamic growth hormone testing
ii. Investigation and management of patients with
hypoglycemia
iii. Patients with ambiguous genitalia;
initially and in crisis.
iv. Dynamic testing for
patients with puberty disorders.
( See attached
protocols for the different tests done in the
unit)
Outpatient Policy:*
Outpatient service:Sunday: Dr. Majedah
Abdul-Rasoul, Dr. Hessa Habib and Dr Maha Alkholy
* Dynamic tests are
done on Wednesdays in Ward 7.
