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Insulin Pump Continuation in the Hospital

This guide outlines the procedure for initiating and monitoring continuous subcutaneous insulin infusion (CSII) pump therapy in the hospital setting. It discusses patient eligibility, dosing options, modifying settings, and monitoring blood glucose levels. The roles of healthcare team members and discontinuation criteria are also covered.

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Insulin Pump Continuation in the Hospital

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

  2. Objectives • Provide guidance for physicians and physician extenders 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. 1. Search “insulin pump” Insulin Pump PowerPlan 2. Be sure to select PowerPlan icon 3. Click the evidence link icon to print “Patient Agreement Form”

  4. Insulin Pump Patient Agreement • Must be completed by physician

  5. Determining Patient Eligibility • Only physicians can: • Initiate continuation or resumption of continuous subcutaneous insulin infusion (CSII) pump • Determine if patient is suitable for managing CSII pump therapy

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

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

  8. Initiating Insulin Pump Therapy • After initiating PowerPlan, task will fire for nursing to fill out this form with the patient

  9. Insulin Pump PowerForm • After signing PowerPlan, Insulin Pump Settings PowerForm will appear to be completed • There are 2 dosing options: • Simple Dosing PowerForm (up to 4 basal rates) • Advance Dosing PowerForm (>4 basal rates, fields for ISF, carb ratio and target blood glucose)

  10. Insulin Pump PowerForm • Be sure to choose the correct type of insulin, based on the PowerPlan order PowerPlan: PowerForm:

  11. 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

  12. 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

  13. 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 View: Will show insulin pump refills (does not contain dosing information)

  14. Insulin Pump Diary/Flowsheet

  15. 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

  16. Questions?

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

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