Adult Standardised Subcutaneous Insulin Prescribing Chart August 2013.
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Transcript of Adult Standardised Subcutaneous Insulin Prescribing Chart August 2013.
![Page 1: Adult Standardised Subcutaneous Insulin Prescribing Chart August 2013.](https://reader037.fdocuments.in/reader037/viewer/2022110303/55170b60550346f5558b52fb/html5/thumbnails/1.jpg)
Adult Standardised Subcutaneous Insulin
Prescribing Chart
August 2013
![Page 2: Adult Standardised Subcutaneous Insulin Prescribing Chart August 2013.](https://reader037.fdocuments.in/reader037/viewer/2022110303/55170b60550346f5558b52fb/html5/thumbnails/2.jpg)
Case for Change• Insulin is a high risk medication• Reported in top 10 high alert medicines worldwide• Nearly 3000 incidents in IIMS• Variation in insulin charts, charting; prescription,
administration and documentation• Variation in access to specialist services and glycaemic
management guidance• Mobile workforce• Need to improve management and patient safety • Risk minimisation for patients
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Methodology• Review of NSW and national charts
• Widespread clinical input
• Developed standardised chart
• Pilot - Ryde and Royal Prince Alfred
• State wide consultation - parallel to State Forms process
• Chart revised
• Endorsed by Medication Safety Expert Advisory Committee (MSEAC)
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What does it mean for me?• Separate chart from NIMC
• Use in adult acute inpatient settings
• Intravenous and specialty charts - unchanged
• Document and use differently
• All glycaemic information linked:
• Prescription and administration
• Easier referral to readings
• Access to best practice guidelines; at bedside
• Standardised chart = standardised practice; communication, documentation and interpretation
• Better patient care
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Key principles• Combined monitoring and
guidelines - minimise delay in management decisions
• Clinicians without local guidelines have clear guidelines for:
Insulin prescription Insulin administration Management of hypo and
hyperglycaemia Safe use of supplemental insulin
• Do not take the place of local guidelines or policies
• Reduced risk of error
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Four Sections• Page 1, including top of page 3:
‾ Patient Identification and demographics‾ Alerts‾ Codes for not administering‾ Instructions‾ Guidelines for prescription and administration‾ Special instructions
• Page 2 and 3:‾ Regular, supplemental, once only and telephone orders‾ BGL and ketone monitoring
• Page 4:‾ Guidelines for glycaemia management
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Patient Identification and demographics
• All charts require ID label affixed consistent with NIMC‾ MRN‾ Name (family and given)‾ Gender‾ DOB‾ Medical Officer (MO)‾ Address‾ Location
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Allergies and Adverse Drug Reactions (ADR)• Clinical staff to complete Allergies and ADR• Select Nil Known, Unknown or;• If allergy exists document:
‾ Name of drug/substance‾ Reaction details
• Person documenting required to:‾ Sign‾ Print name and;‾ Date the entry
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Alerts• Prescriber document
who to notify if certain criteria met e.g. BGL or ketones out of range
• If no alerts select Nil• All entries signed and
dated
• If alert changed- cross out, sign and date it and enter new alert
• Enter details in health care record
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Reason for not administering
• Complete when unable to administer insulin
• Codes to be circled• If dose refused, notify prescriber• If withheld, document reason in health
care record• If not available - obtain supply or contact
prescriber
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Instructions
• The chart is used for:‾ All insulin prescriptions, except IV‾ Recording BGL and ketones, for patients on subcutaneous
insulin
• Specify frequency of monitoring (page 3)‾ Unstable BGLs require more frequent monitoring
• All patient management must also be documented in health care record
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Guide: Prescription & Administration• Daily review and prescription recommended:
‾ May order ahead if glycaemic status stable
• Modify requirements - Peri-operative and modified diets• Target BGL range 5-10mmol/L, except pregnancy• Do not re - write units, it is pre printed• Orders:
‾ No alterations to original order‾ Discontinue by line through insulin name, 2 oblique lines in
administration column on day of discontinuation, sign and date
• Abdomen is preferred injection site
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Additional information and instructions• Indicate if patient is on:
‾ Insulin pump ‾ Other diabetes medication
• Special instructions:‾ To communicate information at bedside e.g. supervise using
insulin pen‾ Can be completed by any staff member
NB: All patient management must also be documented in the patients health care records
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• Daily orders- may be in advance if stable
• Regular subcutaneous orders must contain: ‾ Type of insulin‾ Date prescribed‾ Frequency‾ Time of administration‾ Dose‾ Prescriber’s signature and name printed‾ Prescribers contact
• Administration record must contain:‾ Time given‾ Initials of administrator‾ Initials of 2nd person checking
• Before administering regular insulin check if supplemental insulin is ordered and needed
NB: Two staff to initial and record time given, one of which must be a registered nurse
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Supplemental Insulin• Guidelines page 4• Daily review and adjustment of regular insulin during
acute phase of illness• Not a replacement for regular insulin doses• Best given before a meal, in addition to usual insulin • If repeated doses needed - consider adjustment of regular
doses• Prescribed based on preferred range in space provided
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Supplemental Insulin prescription
• Order must contain: ‾ Type of insulin‾ Date prescribed‾ Time of administration- before meals or specify‾ Dose for each BGL threshold‾ Prescribers signature, name and contact
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Supplemental Insulin administration
• Administration record must contain: ‾ Date‾ Time ‾ Dose‾ Initials of administrator‾ Initials of 2nd person checking
NB: One nurse must be a registered nurse
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Page 3• Blood glucose and ketone monitoring
Frequency selected Hypo record and treatment comments (right hand side)
• Once only subcutaneous insulin (bottom)• Telephone orders
4 Most be signed within 24 hrs
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• Patients on subcutaneous insulin only• Frequency indicated by tick box• BGLs - relate to day of insulin administration • Hypoglycaemia section- extra BGL and action columns,
record episodes and treatment
NB: All hypoglycaemic episodes should be managed immediately & include assessment for clinical review and must be fully document in health care record
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Once Only S/C Insulin
• Specify date and time dose to be administered• Nursing staff must initial and record time insulin
administered
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Telephone Orders
• As per NSW Health policy • Refer to local policies• Signed within 24 hrs by MO
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Page 4• Guidelines for:
‾ Management of hypoglycaemia‾ Management of hyperglycaemia‾ Use of supplemental insulin and correction of
hyperglycaemia
• For areas without local guidelines, policy or specialist support
• Don’t take the place of local guidelines or policy
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Acknowledgements• Inpatient Management Working Group• The many clinicians who have contributed to development
and pilot of the Subcutaneous Insulin Medication Chart
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Questions, Comments, Observations….
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Contact
Rebecca DonovanPH: 9464 4626
Melissa Tinsley PH: 9464 4653