Insulin Orders & Protocols: Subcutaneous

Annotative Examples of Subcutaneous Insulin Order Forms

University of California, San Diego (UCSD)
A "next generation" order set which shows how the algorithm from the Building and Implementing Subcutaneous Insulin Order Set/Protocol section with its suggested pathways can drive turning your order set into a more protocol-like approach.
View the UCSD Order Set

Good Samaritan Regional Medical Center, Phoenix, Arizona
This example is courtesy of Cheryl O'Malley, MD, the local hospitalist champion at Good Samaritan. Note that a high degree of integration of institutional preferences and guidance can be incorporated in this environment with paper orders, just as it can be in the CPOE environment, in the UCSD example.
View the Good Samaritan Regional Medical Center Basal Insulin Order Set

University of California, San Francisco
This example is courtesy of the University of California, San Francisco, and Dr. Robert Rushakoff. You can again see the high degree of guidance that can be incorporated into your order sets, regardless of whether you are in a paper-based or CPOE ordering environment.
View the UCSF Order Set

Washington Hospital Medical Center
This example is brought to us by Michelle Magee, MD, from Washington Hospital Medical Center and the MedStar Health Institute. It incorporates many core components of the ideal SQ insulin order set, including specification of the DM diagnosis, A1C order, FSBG frequency, hypoglycemia treatment, and basal bolus plus correction-dose orders, and makes allowance for eating, NPO, tube feeds, and transition from IV to SQ insulin order. The first page is only used once. The second page is the core insulin-ordering page. The prescriber rips off the first page and uses only the second for subsequent orders.
View the Washington Hospital Medical Center Order Set

Admission Orders for General Internal Medicine
Shands University of Florida. This institution uses a form for ALL admissions and includes prompts for ordering basal and prandial insulin rather than having a separate order form.
View Admission Orders for General Internal Medicine.

Glycemic Management Order Set
Susan S. Braithwaite, Diabetes Consult Service.
View Glycemic Management Order Set.

Adult Subcutaneous Insulin Orders
Medical University of South Carolina. Short and long forms, submitted by Susan Braithwaite.
View Adult Subcutaneous Insulin Orders - Short Form.
View Adult Subcutaneous Insulin Initial Orders -Long Form.