Insulin order sets – only way to order sustained insulin. Separate versions for 1 st time order and revision.

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Presentation transcript:

Insulin order sets – only way to order sustained insulin. Separate versions for 1 st time order and revision.

Note prompt to DC oral agents, instructions for out of range glucose values, multiple versions of SC insulin orders for different forms of nutritional intake

Multiple appropriate CHO limited diets incorporated into DM order set

Guidance for calculating TDD, warning against correction only insulin regimens for Type 1 DM and those with hyperglycemia. Nurse driven hypoglycemia management protocol – see paper algorithm as well A1c checked off IF not already available. If already in the system, it does not appear as order.

For eating pt, led thru basal / bolus: glargine, lispro nutritional, lispro correction. Other insulins not offered. Note glargine / lispro dosing guidance For eating pt, led thru basal / bolus: glargine, lispro nutritional, lispro correction. Other insulins not offered. Note glargine / lispro dosing guidance Glucose and latest A1c pulled in to order set. Epic did not allow autocalculation. Buttons offer easy dosing.

For eating patient lispro nutritional insulin dosing comes up next, see dosing guidance, and not administration instructions

Smart text triggers appropriate correction scale. Monitoring choices always match nutritional intake. See correction scale detail next slide.

Correction Insulin Low Dose CorrectionModerate Dose Correction High Dose Correction Provider Specified Correction 1:50 >150 qac and > 200 qhs 1:25 >150, starting at 3 qac and >200, starting at 4 qhs 1:25 >150 qac and > 200 qhs

Option for those getting varied CHO intake with each meal

Carb counting option: generally recommended for hospitals more advanced, Type 1 DM patients

For continuous TF, guidance for glargine as basal insulin, regular q 6 hours nutrtional / correctional

Night-Only continuous nutrition order panel added. Original continuous nutrition order panel display name revised to read “24-hour…”

The order group Description field instructions for the night-only option. Here are the orders for the order group.

Here is the scheduled regular insulin order. Note the default schedule at 1800 and Default Administration instructions are shown.

NPO / clear liquids – guidance for glargine as basal, correction with regular q 6 hours, no nutritional insulin

Correction only regimen for those eating meals – discouraged unless glucose < and Type 2 or no DM - for eating patients, correction is lispro with meals

Same caveats apply, but regular q 6 hours used as correction insulin

Prompts to get glucometer etc. See also DM equipment orders at DC