Slide 1

Evidence Based Care Program

Subcutaneous Insulin Order Set

arawn@gbhs.on.ca

This is a slide show presentation from the Evidence Based Care program regarding the use of the Subcutaneous Insulin Order Set.

For further teaching or inservice requests regarding specific order sets or other elements of the EBCP, please contact Andrea Rawn at arawn@gbhs.on.ca1Order Sets and PathwaysGrey Bruce Health Network (GBHN) is a collaboration of 3 corporations, CCAC and Public HealthGrey Bruce Health Services 6 sitesHanover and District Hospital 1 siteSouth Bruce Grey Health Centre 4 sitesEvidence Based Care Program has 10 pathways and almost 120 order sets and protocolsOrder Sets are owned by the physicianPathways/Doc in Plan owned by the nurses

The Evidence Based Care Program is a collaborative project of the Grey Bruce Health Network consisting of the three hospital corporations in Grey and Bruce. To date there are 10 pathways and 120 order sets and protocols. Two of the pathways, now called document in plans, are electronic and released for use. Technically the order sets are Owned by the Physicains and can ONLY BE implemented by a physician or on behalf of a physician with a signature pending. The pathways are implemented by the nursing staff to guide the treatment course of the patient through their admission.

2Order Sets are a TOOL for the physician and can only be implemented by the physicianOrders not required can be stroked out, while other orders can be addedPathways/Doc in Plans are TOOLS for the nursesNurses can implement these without a physician order and critique the care based on the individual patient Both are based on best practice, practice guidelines, and are evidence based where evidence is available

The order sets are designed to be used as a TOOL to assist the physician and associated disciplines as a guide to best practice. The order sets can be further critiqued to suit the individual needs of the different patient condition and co morbidities. The physician is free to stroke out those orders that do not apply to their patients and add those that do. All order sets are based on best practice guidelines, research and expert knowledge.

3ChangeHow can we change what we do to effectively have a direct impact on patient outcomes?Is it possible to change habits?

http://www.youtube.com/watch?v=2lXh2n0aPyw

The following clip is food for thought. It puts an interesting prespective on the way we preceive work and change.Click on open hyperlink and enjoy. Think of the processes that would benefit from this trial when you return to work.5

Each order set and protocol is labelled with a title according to the content and diagnosis.

Any Inclusion or Exclusion criteria that applies is listed here. For example in this order set This order is not to be used for patients who are NPO.6

All order sets that have been validated for use appear with the network logo in the Header. Any other versions are outdated, not validated, or not from the network repository and should be reported to the Co ordinator of the Evidence Based Program for follow up.

The patient identification sticker is placed in the right upper hand corner.

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Brief instructions for use are listed next.

An open box indicates an order that CAN BE selected by the physician. A checked box is an order that IS PRESELECTED by the physician unless crossed out.

The physician can cross out any order that he feels does not apply to his patient. The physicians are encouraged to eliminate the entire line and rewrite the new order and not to modify an existing line as this may lead to errors.8

This protocol is unselected and must be ordered by the physician.It enables the dietician, working within their full scope of practice, to consult with the patient for likes and dislikes and to determine how many calories would be appropriate for this hospital visit according to their admission diagnosis.

It can also begin fundamental teaching of dietary requirements to be followed up and elaborated on, once back in the community.

This protocol can be printed separately, but for the most part there is nothing on it for the nursing staff to do but consult the dietician.

The physicians all need to be aware of what is listed on this protocol, although not all items will apply, as this protocol is used in a variety of diagnosis.9

POC GLUCOSE MONITORINGThis section has both selected and unselected portions.Standardized time frames are to be selected as per corporate policy and meal times.This is followed by preselected instruction as to what to do if POC glucose is low or high. There are 2 different parameters outlined in this section. The first set (20) are the parameters to contact the physician. The second parameter (