Insulin Orders & Protocols: Subcutaneous

Annotative Examples of Subcutaneous Insulin Order Forms

Protocols and Order Sets

Example Protocol: Stepwise Approach to Managing Inpatient Hyperglycemia
This protocol was published in The Journal of Hospital Medicine as part of the SHM Glycemic Control Task Force Supplement, Improving Care of the Hospitalized Patient with Hyperglycemia and Diabetes. View the supplement chapter: Subcutaneous Insulin Order Sets and Protocols: Effective Design and Implementation Strategies for context and more information about implementation.
View the Institutional Protocol Example

Example: Protocol Driven SC Insulin Order Set
This order set was published in The Journal of Hospital Medicine as part of the SHM Glycemic Control Task Force Supplement, Improving Care of the Hospitalized Patient with Hyperglycemia and Diabetes. View the supplement chapter: Subcutaneous Insulin Order Sets and Protocols: Effective Design and Implementation Strategies for context and more information about implementation.
View the Institutional Order Set Example

CPOE Based Order Set

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

The article below provides more information on how UCSD integrated and monitored the integration of the CPOE based order set as well as what was further done to streamline the process.

Indication Based Ordering: A New Paradigm for Glycemic Control in Hospitalized Inpatients
Lee J, Clay B, Ziband Z, Clay B, Maynard G. J Diabetes Science Tech May 2008, Vol 2 (3) 349 – 356.

Paper Based Order Sets

Good Samaritan Regional Medical Center, Phoenix

Basic Subcutaneous Insulin Order Set, Tube Feeds Subcutaneous Insulin Order Set, and Physicians Dosing Guidelines for Subcutaneous Insulin
These examples are 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 Basic Subcutaneous Insulin Order Set
View the Tube Feeds Subcutaneous Insulin Order Set
View the Physicians Dosing Guidelines for Subcutaneous Insulin

University of New Mexico
Subcutaneous Insulin Order Set & Nursing Insulin Administration Record
This is a paper based subcutaneous insulin order set from the University of New Mexico (UNM) for eating and NPO patients, you will note clinical decision support throughout and very clear guidelines and steps to the physicians, HUCs, and nurses using this form.  The nursing insulin administration record incorporates the guidance specific to nurses on the form they will be referring to.
View the UNM Insulin Order Set
View the UNM Nursing Insulin Administration Record

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

Example of a complete compliment of subcutaneous order sets from one institution:

Loyola Order Sets:
Non-ICU Insulin Therapy of Hyperglycemia in Adults who are eating /getting continuous tube feedings
Loyola University Health System. Guidelines and Ordersets, submitted by Maryann Emanuele.
View the Guideline for Continuous Tube Feeds Plus General Diet
View the Guideline for Clear/Full Liquid Diet
View the Orderset: Adult Patients Receiving Continuous Tube Feedings
View the Orderset: Adult Patients Receiving Continuous Tube Feedings Plus Clear/Full Liquid Diet
View the Orderset: Adult Patients Receiving Continuous Tube Feedings Plus General Diet
View the Orderset: Adult Patients Transitioning From Tube Feedings to Solids

Other Subcutaneous Order Sets