1. Insulin Pump Continuation in the Hospital
Shaylyn Vogler, PharmD
PGY1 Pharmacy Resident

2. Objectives
Provide guidance for pharmacists on the procedure for initiating continuous subcutaneous insulin infusion (CSII) pump therapy
Briefly discuss the roles of various healthcare team members in the CSII pump continuation protocol

3. Initiating the PowerPlan for Insulin Pumps
Only providers can:
Initiate continuation or resumption of continuous subcutaneous insulin infusion (CSII) pump
Determine if patient is suitable for managing CSII pump therapy
Contraindications to using patient’s own CSII pump
Pump settings irretrievable from pump
Inability to demonstrate competency for pump use
Altered level of consciousness
Inability/ refusal to participate
Necessary pump supplies unavailable
Risk of suicide
Diabetic Ketoacidosis
Hyperglycemic Hyperosmolar State
Critically ill or hemodynamically unstable
CSII pump not working properly

4. Insulin Pump PowerPlan
1. Search “insulin pump”
2. Be sure to select PowerPlan icon
3. Click the evidence link icon to print “Patient Agreement Form”

5. Insulin Pump Patient Agreement
Must be completed by provider

6. Insulin Pump PowerPlan
4. Select appropriate insulin product using Patient’s Insulin Pump Settings form

7. Insulin Pump PowerPlan
5. Decide whether Provider or Pharmacist will complete Insulin Pump Settings in PowerForm

8. Initiating Insulin Pump Therapy
After initiating PowerPlan, task will fire for nursing to fill out this form with the patient or surrogate
Form is then scanned into Pyxis Connect
Should expect questions!

9. Initiating Insulin Pump Therapy
After initiating PowerPlan, task will fire for pharmacy (if physician selected for pharmacist to complete PowerForm)
Pump settings must be entered within 24 hours

10. Insulin Pump PowerForm
Simple Dosing PowerForm
Insulin selection
Basal rate (up to 4)
Meal bolus, select one:
Insulin to carb ratio, or
Fixed insulin
Insulin sensitivity factor (ISF)/Correction bolus
Blood glucose target ranges
Documentation of where insulin pump settings were obtained
Advance Dosing PowerForm
Insulin selection
Basal rate (up to 24)
Meal bolus, select one:
Insulin to carb ratio
Fixed insulin, or
Units per servings of carbohydrates
Insulin sensitivity factor (ISF)/Correction bolus
Blood glucose target ranges
Documentation of where insulin pump settings were obtained

11. Insulin Pump PowerForm
Choose the correct type of insulin, based on the PowerPlan order
Select appropriate therapeutic interchanges for all non- formulary insulins
PowerPlan:
PowerForm:

12. Refilling Insulin Pumps
Pharmacy dispenses insulin to refill pumps
Nurse must sign for insulin and document waste
Signed delivery form scanned into Pyxis Connect
Unused portions of U-200 or U-500 must be returned to pharmacy by the same pharmacy staff who delivered it
Be sure to choose correct insulin (“for pump refill”)

13. Scanning Insulin
Nurse will scan the label barcode, not the vial or pen

14. Modifying Insulin Pump Settings
Process different than other modify order processes
An order to Modify Insulin Pump Settings must be entered:
The Insulin Pump Settings PowerForm will appear with last charted values populating the fields
Modify insulin pump settings and sign the PowerForm

15. Monitoring Bedside blood glucose AC and HS at minimum
As needed for signs and symptoms of high or low blood sugar
Nursing will assess patient’s ability to manage pump at least once every shift using either
Insulin Pump Patient Checklist
Insulin Pump Surrogate Checklist

16. Elevated Blood Glucose
If BG is >250 mg/dL on 2 or more consecutive occasions:
Administer correction bolus via insulin syringe (pump infusion set may be nonviable)
Patient’s blood glucose to be tested 4 hours after dose and call made to physician if BG still >250 mg/dL

17. Viewing Current Insulin Dosing
Basal Rates: found on Results Review page under glucose data or on the Insulin Pump Settings PowerForm
Bolus Doses: not entered into Cerner; charted on paper Insulin Pump Diary/Flowsheet, which may be found at bedside or in physical chart (see next slide)
MAR Summary View: Will show insulin pump refills (does not contain dosing information)

18. Insulin Pump Diary/Flowsheet

19. Discontinuation of Pump
Pump to be discontinued if:
Patient or surrogate fails to qualify for initiation or continuation
CSII pump is discontinued or interrupted for >1 hour

20. Questions?

21. Shaylyn Vogler, PharmD PGY1 Pharmacy Resident
Thank you!
Shaylyn Vogler, PharmD
PGY1 Pharmacy Resident