Diabetes Through Surgery Questionnaire
We would be grateful if you would fill in this questionnaire to help the hospital diabetes team and the theatre recovery nursing staff to assess what type of care diabetic patients receive before, during and after an operation.
Q1.
Were you given written information about how your diabetes would be affected by the operation?
Yes
No
Q2.
If YES to Q1, who gave you this information?
GP
Outpatient Department
Ward Staff
Other
Q3.
Were you given written information about how your diabetes would be managed during your stay in hospital?
Yes
No
Q4.
If YES to Q3, who gave you that information?
GP
Outpatient Department
Ward staff
Other
Q5.
Was it VERBALLY explained to you how your diabetes would be managed during your stay in hospital?
Yes
No
Q6.
If YES to Q5, who explained?
GP
Outpatient Department
Ward staff
Other
Q7.
Were you told the affect that the anaesthetic may have on your diabetes?
Yes
No
Q8.
Do you feel that you were given adequate information about the effect your operation may have on your diabetes control?
Yes
No
Q9.
If NO to Q8, what other information do you think you should have been given?
Q10.
Please tell us any comments you may have about your inpatient stay in relation to your diabetes:
Q11.
Whilst in hospital, do you feel that your personal ability to manage your diabetes was respected?
Yes
No
Q12.
If NO to Q11, please tell us about your experience:
Q13.
Please indicate what type of procedure you underwent:
Abdominal surgery
Gynaecological surgery
Opthalmic (eye) surgery
Orthopaedic (bone) surgery
Other
Q14.
Was this:
Day Case
Inpatient
Q15.
Date of procedure:
Q16.
How long following surgery was your normal diabetic control achieved?
Up to 1 week
Up to 2 weeks
Up to 3 weeks
Up to 4 weeks
Over 4 weeks
Q17.
Are you still having problems controlling your diabetes?
Yes
No
Q18.
Date you completed this form:
Q19.
Please use this space to elaborate on any answers or make general comments:
Thank you for your time.

Please return the completed questionnaire in the pre-paid envelope provided.


This survey was created byKeyPoint