CSII (CONTINUOUS SUBCUTANEOUS INSULIN INFUSION) AND INPATIENT ADMISSION
|
|
|
- Gwendoline Fisher
- 8 years ago
- Views:
Transcription
1 CSII (CONTINUOUS SUBCUTANEOUS INSULIN INFUSION) AND INPATIENT ADMISSION
2 Goals of Inpatient Glucose Management Avoid Hypoglycemia (Serum glucose <70 mg/dl) Dangerous due to the effects of counter-regulatory hormones (i.e. catecholamines), which can induce arrhythmias. Avoid Severe Hyperglycemia Which can lead to volume depletion and electrolyte abnormalities Ensure Adequate Nutrition Inpatients are outside their normal environment. Nutritional routines change and the type of food consumed is outside their norm.
3 Glycemic Targets Non-Critically Ill The ADA/AACE recommends pre-meal glucose of < 140 mg/dl and random glucose of <180 mg/dl for general hospitalized patients (consensus recommendation only) Critically Ill The ADA/AACE recommends a blood glucose target of 140 to 180 mg/dl. Achieving this goal may take an insulin infusion Acute MI American Heart Association recommends the use of an insulin infusion when glucose values are >180 mg/dl (10 mmol/l) in patients with an MI and a complicated course NICE-SUGAR (Intensive versus Conventional Glucose Control in Critically Ill Patients) In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter. (ClinicalTrials.gov number, NCT ) Well managed glycemic control avoids complications in hospitalized patients, reduced inpatient time, reduced risk of infection, promotes healing.
4 Models of Glycemic Management Sliding-Scale i.e. if POC glucose is mg/dl, give 2u SQ NOVOLOG Not tailored to the individual patient outside of BMI and diet. Does not adjust to increasing or decreasing sensitivity of the patient or changes in condition Corrective Varied doses of short acting and long acting insulin, typical 50/50 rule based on BMI and estimated needs. Tools such as The Glucommander by Glyetec adapt the corrective insulin through data collection and patient surveillance. Highly dependent on the accuracy of nursing staff estimates of choleric intake. Infusion Continuous IV infusion of insulin as used in the treatment of DKA. This has allows for quicker adjustment of based on insulin demands, but requires more frequent monitoring of blood glucose and a higher level of training than what is on the medical floor to maintain.
5 What about the Insulin Pump?
6 The Insulin Pump Many advances in the last few years. Highly customizable, self-managed, glucose monitoring, detailed logging, trending, alarms, multiple modes based on activity and dietary intake, highly efficient and becoming more prevalent in the DMII patient.
7 CSII and the Inpatient Benefits Well controlled diabetics with insulin pumps are able to maintain euglycemia in the inpatient setting through self monitoring and insulin dosing/adjustment. Their insulin routine is not disrupted, insulin is not changed nor the timing of their dosing. Caveats The patient must be fully capable of managing the pump. They can not be intubated, sedated or too sick to think clearly. Nursing needs to have additional training on monitoring a patient who is self-dosing through an insulin pump. Additional charting is mandatory for patient safety. The specific disposable/limited use equipment must be brought by the patient. i.e. infusion sets and specific insulin.
8 CSII and the Inpatient Few studies have been done. One retrospective analysis was in Journal of Diabetes Science and Technology, Volume 4, Issue 4, July This analysis included inpatient CSII from , a total of 65 patients and 125 admissions. Mean glucose of 175 mg/dl was observed and found to not be significantly different than those patients where the pump was discontinued or intermittently used. Based on the record review, which included nursing flow sheets, patients can safely operate their insulin pumps. However there appears to be room for optimization of glucose control when pumps are allowed to be patient maintained during hospital admissions.
9 Surgery and Insulin Pumps One of the criteria for allowing patient managed insulin pumps was ability to monitor and manage. What do you do when your patient needs to go to surgery? Majority of hospitals have specific diabetes protocols regarding surgery, with expected pre-surgical treatments (i.e. specific IVF s), acceptable blood glucose ranges, and post-op diabetic goals. This is one area where insulin pumps can not be continued. Most reviewed protocols have the pumps being discontinued 24 hours prior to surgery to allow for surgical protocols to be implemented. Reinstatement of the pump can occur once the patient meets criteria post-op
10 Conclusion Insulin pumps with proper management provide an euglycemic state. The technology available provides all the tools necessary for a trained physician to adjust the pump to individual. Pump usage in the inpatient environment has not been shown to significantly improve glucose management but has also not been show to cause harm. Many organizations have elected to allow pump usage to maintain a proved diabetic regimen while inpatient. Additional training of nursing staff is required for the workflow surrounding patient maintained glycemic control. Additional charting and monitoring is required
11 References Policy: Use of Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in the Hospital: Shore Health System, University of Maryland Medical System Dalton M, Klipfel L, Carmichael K. 2006, Safety Issues: Use of Continuous Subcutaneous Insulin Infusion (CSII) Pumps in Hospitalised Patients, Hospital Pharmacy, vol. 41, no.10, pp Cook C, Boyle M, Cisar N, Miller-Cage V, Bourgeois P, Roust L, Smith S, Zimmerman R Use of Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in the Hospital Setting: Proposed Guidelines and Outcome Measures. The Diabetes Educator, vol 31, pp Policy: JOSLIN DIABETES CENTER and JOSLIN CLINIC GUIDELINE for INPATIENT MANAGEMENT OF SURGICAL and ICU PATIENTS with DIABETES (Pre, Peri and Postoperative Care) 10/02/09. Outpatient-to-Inpatient Transition of Insulin Pump Therapy: Successes and Continuing Challenges Adrienne A. Nassar, M.D.,1 Brenda J. Partlow, C.N.P., N.P.,2 Mary E. Boyle, C.N.P., N.P.,2 Janna C. Castro, B.S.,3 Peggy B. Bourgeois, A.P.R.N., M.N.,4 and Curtiss B. Cook, M.D.2, Journal of Diabetes Science and Technology Volume 4, Issue 4, July 2010 Continuous Subcutaneous Insulin Infusion (CSII) in Inpatient Setting: Unmet Needs and the Proposal of a CSII Unit, Lelio Morviducci, M.D., Ph.D.,1 Alessandra Di Flaviani, M.D.,2 Angelo Lauria, M.D.,3 Dario Pitocco, M.D., Ph.D.,4 Paolo Pozzilli, M.D., Ph.D.,3 Concetta Suraci, M.D.,5 and Simona Frontoni, M.D., Ph.D.,2 for the CSII Study Group of Lazio Region, Italy, DIABETES TECHNOLOGY & THERAPEUTICS Volume 13, Number 10, 2011 Use of Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in the Hospital: A Review of One Institution s Experience, Brenda J. Leonhardi, M.S.N., FNP-C,1 Mary E. Boyle, C.N.P., C.D.E.,1 Karen A. Beer, P.A., C.D.E.,1 Karen M. Seifert, M.S., C.D.E.,2 Marilyn Bailey, R.N., M.S.,2 Victoria Miller-Cage, M.S., F.N.P.,3 Janna C. Castro, B.S.,4 Peggy B. Bourgeois, A.P.R.N., M.N.,5 and Curtiss B. Cook, M.D.1, Journal of Diabetes Science and Technology SYMPOSIUM Volume 2, Issue 6, November 2008 Intensive versus Conventional Glucose Control in Critically Ill Patients, The NICE-SUGAR Study Investigators, N Engl J Med 2009; 360: March 26, 2009DOI: /NEJMoa
12 Questions?
Inpatient Guidelines: Insulin Infusion Pump Management
Inpatient Guidelines: Insulin Infusion Pump Management Developed by the Statewide Diabetes Clinical Network Steering Committee July 2012 Clinical Access and Redesign Unit Table of Contents Purpose...4
Inpatient Treatment of Diabetes
Inpatient Treatment of Diabetes Alan J. Conrad, MD Medical Director Diabetes Services EVP, Physician Alignment Diabetes Symposium November 12, 2015 Objectives Explain Palomar Health goals for inpatient
INPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco
INPATIENT DIABETES MANAGEMENT Robert J. Rushakoff, MD Professor of Medicine Director, Inpatient Diabetes University of California, San Francisco CLINICAL RECOGNITION Background: Appropriate inpatient glycemic
Managing the Hospitalized Patient on Insulin: Care Transition. Catie Prinzing MSN, APRN, CNS
Managing the Hospitalized Patient on Insulin: Care Transition Catie Prinzing MSN, APRN, CNS Diabetes and Hospitalization People with DM are hospitalized 3x more frequently than patients without diabetes
Glucose Management University of Colorado Hospital
Glucose Management University of Colorado Hospital Bridget Everhart, MSN, NP, CDE Inpatient Diabetes Educator Bridget.Everhart@uch.edu M F Pager 303 266-7898 UCH Diabetes Program Michael McDermott MD Diabetes
SARASOTA MEMORIAL HOSPITAL
SARASOTA MEMORIAL HOSPITAL TITLE: NURSING PROCEDURE MANAGEMENT OF PATIENT S OWN INSULIN PUMP/CONTINUOUS SUBCUTANEOUS INSULIN INFUSION PUMP (dia13) DATE: REVIEWED: PAGES: 08/84 10/15 1 of 7 PS1094 ISSUED
Objectives. Clinical Impact of An Inpatient Diabetes Care Model. Impact of Diabetes on Hospitals. The Nebraska Medical Center Stats 6/5/2014
Objectives Clinical Impact of An Inpatient Diabetes Care Model Beth Pfeffer MSN, RN CDE Andjela Drincic, MD 1. Examine the development of the role of the diabetes case manager model in the inpatient setting
Clinical Impact of An Inpatient Diabetes Care Model. Objectives
Clinical Impact of An Inpatient Diabetes Care Model Beth Pfeffer MSN, RN CDE June 4, 2014 Objectives 1. Examine the development of the role of the diabetes case manager model in the inpatient setting 2.
EVALUATION OF A BASAL-BOLUS INSULIN PROTOCOL FROM CONTINUING DOSING EFFICACY AND SAFETY OPTIMIZATION IN NON-CRITICALLY ILL HOSPITALIZED PATIENTS
EVALUATION OF A BASAL-BOLUS INSULIN PROTOCOL FROM CONTINUING DOSING EFFICACY AND SAFETY OPTIMIZATION IN NON-CRITICALLY ILL HOSPITALIZED PATIENTS Joanne Archer, MSN, APRN, BC-ADM, Maureen T. Greene, PhD,
Use of Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in the Hospital: A Review of One Institution s Experience
Journal of Diabetes Science and Technology Volume 2, Issue 6, November 2008 Diabetes Technology Society SYMPOSIUM Use of Continuous Subcutaneous Insulin Infusion (Insulin Pump) Therapy in the Hospital:
at The Valley Hospital (TVH) for Nursing Students/Nursing Instructors 2012
at The Valley Hospital (TVH) for Nursing Students/Nursing Instructors 2012 Subject - Insulin Safety Background Insulin known to be high risk medication Can promote serious hypoglycemia if given incorrectly
Continuous Subcutaneous Insulin Infusion (CSII)
IMPORTANCE OF FOCUS CSII (Insulin pumps) have been used for more than 35 years. In the U.S. in 2005, the level of insulin pump penetration was estimated at 20 to 30% in patients with type 1 diabetes mellitus
CARDIAC SURGERY INTRAVENOUS INSULIN PROTOCOL PHYSICIAN ORDERS INDICATIONS EXCLUSIONS. Insulin allergy
Page 1 of 5 INDICATIONS EXCLUSIONS 2 consecutive blood glucose measurements greater than 110 mg per dl AND NPO with a continuous caloric source AND Diagnosis of : Cardio-thoracic Surgery NOTE: This protocol
Objectives PERINATAL INSULIN PUMPS: BASICS FOR NURSES. Historical Perspective. Insulin Pumps in Pregnancy. Insulin Pumps in the US
Objectives PERINATAL INSULIN PUMPS: BASICS FOR NURSES Jo M. Kendrick, APN BC, CDE jkendric@utmck.edu Describe indications and contraindications for insulin pump use in hospitalized patients Differentiate
Intensive Insulin Therapy in Diabetes Management
Intensive Insulin Therapy in Diabetes Management Lillian F. Lien, MD Medical Director, Duke Inpatient Diabetes Management Assistant Professor of Medicine Division of Endocrinology, Metabolism, & Nutrition
Use of Continuous Subcutaneous Insulin Infusion (CSII) Pumps in Hospitalized Patients Policy and Procedure
Purpose: To ensure safe and accurate administration of insulin for patients using their own external continuous subcutaneous insulin infusion pump during hospitalization. Definitions: Insulin pump: An
Gayle Curto, RN, BSN, CDE Clinical Coordinator
Gayle Curto, RN, BSN, CDE Clinical Coordinator INTRODUCTION Historical Program Overview Leadership Team Mission Statement Diabetes Center Demographics for 2011 Older Adult Population HISTORICAL PROGRAM
[ ] POCT glucose Routine, As needed, If long acting insulin is given and patient NPO, do POCT glucose every 2 hours until patient eats.
![[ ] POCT glucose Routine, As needed, If long acting insulin is given and patient NPO, do POCT glucose every 2 hours until patient eats.](/thumbs/35/17205932.jpg "[ ] POCT glucose Routine, As needed, If long acting insulin is given and patient NPO, do POCT glucose every 2 hours until patient eats.")
Glycemic Control - Insulin Infusion NOTE: For treatment of Diabetic Ketoacidosis or Hyperglycemic Hyperosmolar Syndrome please go to order set named Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar
Glycemic Control Initiative: Insulin Order Set Changes Hypoglycemia Nursing Protocol
Glycemic Control Initiative: Insulin Order Set Changes Hypoglycemia Nursing Protocol Ruth LaCasse Kalish, RPh Department of Pharmacy Objectives Review the current practice at UConn Health with sliding
SECTION: NM NUMBER: 20. HENRY FORD HOSPITAL DETROIT, MICHIGAN TITLE: GLYCEMIC CONTROL INTENSIVE CARE PROTOCOL UNIT: All ICUs
CLINICALPROTOCOL MULTIDISCIPLINARY SECTION: NM NUMBER: 2 HENRY FORD HOSPITAL DETROIT, MICHIGAN TITLE: GLYCEMIC CONTROL INTENSIVE CARE PROTOCOL UNIT: All ICUs APPROVED: 3/3 REVIEWED: REVISED: 12/3, 5/,
Implementing The Portland Protocol - Continuous Intravenous Insulin Infusion in your institution
Implementing The Portland Protocol - Continuous Intravenous Insulin Infusion in your institution Anthony P. Furnary, MD St Vincent Medical Center Providence Health Systems Portland, OR Phased Implementation
Diabetes Expert Witness on: Diabetic Hypoglycemia in Nursing Homes
Diabetes Expert Witness on: Diabetic Hypoglycemia in Nursing Homes Nursing home patients with diabetes treated with insulin and certain oral diabetes medications (i.e. sulfonylureas and glitinides) are
INTERNAL MEDICINE RESIDENTS NOON CONFERENCE: INPATIENT GLYCEMIC CONTROL
INTERNAL MEDICINE RESIDENTS NOON CONFERENCE: INPATIENT GLYCEMIC CONTROL Presented by: Leyda Callejas PGY5 Endocrinology, Diabetes and Metabolism Acknowledgements: Dr. P Orlander Dr. V Lavis Dr. N Shah
Overview of Diabetes
Overview of Diabetes Clinical Services Kena K. Desai MS, MD Diabetes Physician Consultant Alaska Native Tribal Health Consortium Date: 07/30/2015 Diabetes Services Our Vision: A life free of diabetes and
Department of Pharmacy, Kaiser Permanente San Francisco Medical Center, San Francisco 94115, California, USA
Journal of Pharmacy and Pharmacology 3 (2015) 33-38 doi: 10.17265/2328-2150/2015.01.005 D DAVID PUBLISHING Evaluation of Glycemic Control with a Pharmacist-Managed Post-Cardiothoracic Surgery Insulin Protocol
There seem to be inconsistencies regarding diabetic management in
Society of Ambulatory Anesthesia (SAMBA) Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Review of the consensus statement and additional
BASAL BOLUS INSULIN FOR MEDICAL- SURGICAL INPATIENTS
BASAL BOLUS INSULIN FOR MEDICAL- SURGICAL INPATIENTS C O N T A C T D I A B E T E S S E R V I C E S F O R M O R E I N F O R M A T I O N 8 4 7-9 1 7-6 9 0 7 THIS SLIDE PRESENTATION WAS PREPARED BY SUE DROGOS,
Targeting Hypoglycemia in the ICU with Evidence Based Practice Strategies
Targeting Hypoglycemia in the ICU with Evidence Based Practice Strategies Ruth Kleinpell PhD RN FAAN FCCM Rush University Medical Center Chicago Illinois USA Research substantiates the benefit of insulin
2011 EBM-hyperglycemia
嗎 2011 EBM-hyperglycemia 陳 莉 瑋 醫 師 一 定 要 打 打 bolus insulin? 用 FinePrint 列 印 - 可 在 www.ahasoft.com.tw/fineprint 訂 購 Question 1 Is bolus insulin necessary in DKA? P:DKA adult patient I:initial bolus insulin+insulin
Criteria: CWQI HCS-123 (This criteria is consistent with CMS guidelines for External Infusion Insulin Pumps)
Moda Health Plan, Inc. Medical Necessity Criteria Subject: Origination Date: 05/15 Revision Date(s): 05/2015 Developed By: Medical Criteria Committee 06/24/2015 External Infusion Insulin Pumps Page 1 of
Mind the Gap: Navigating the Underground World of DKA. Objectives. Back That Train Up! 9/26/2014
Mind the Gap: Navigating the Underground World of DKA Christina Canfield, MSN, RN, ACNS-BC, CCRN Clinical Nurse Specialist Cleveland Clinic Respiratory Institute Objectives Upon completion of this activity
Ten Ways to Prevent Insulin-Use Errors in Your Hospital. ASHP Research and Education Foundation May 14, 2014
Ten Ways to Prevent Insulin-Use Errors in Your Hospital ASHP Research and Education Foundation May 14, 2014 To Ask Questions and Adjust the Control Panel Expand or Collapse Type your question here Faculty
The Joint Commission Advanced DSC Certification for Inpatient Diabetes Care
The Joint Commission Advanced DSC Certification for Inpatient Diabetes Care November 12, 2013 Caroline Isbey RN, MSN, CDE Associate Director Teresa Gomez Associate Project Director Specialist-SSM Carol
Intensive Glucose Management in Critically Ill Patients Improves Patient Outcomes
PHARMACY PRACTICE PAPER Intensive Glucose Management in Critically Ill Patients Improves Patient Outcomes Nora Padilla, RPh University of Florida Working Professional Doctor of Pharmacy Program Spring
School Nurse Role in Care and Management of the Child with Diabetes in Colorado Schools and Child Care Settings Position Statement 1 POSITION It is
Schools and Child Care Settings Position Statement 1 POSITION It is the position of the Colorado Diabetes Resource Nurses that the school nurse is the only school staff member who has the skills, knowledge
8/5/2015. Double Checking Practices. Background. Does a Double Checking Insulin Procedure Improve Patient Safety?
Disclosure to Participants Notice of Requirements For Successful Completion Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to
tips Insulin Pump Users 1 Early detection of insulin deprivation in continuous subcutaneous 2 Population Study of Pediatric Ketoacidosis in Sweden:
tips Top International Publications Selection Insulin Pump Users Early detection of insulin deprivation in continuous subcutaneous insulin infusion-treated Patients with TD Population Study of Pediatric
NCT00272090. sanofi-aventis HOE901_3507. insulin glargine
These results are supplied for informational purposes only. Prescribing decisions should be made based on the approved package insert in the country of prescription Sponsor/company: Generic drug name:
Diabetic Ketoacidosis: When Sugar Isn t Sweet!!!
Diabetic Ketoacidosis: When Sugar Isn t Sweet!!! W Ricks Hanna Jr MD Assistant Professor of Pediatrics University of Tennessee Health Science Center LeBonheur Children s Hospital Introduction Diabetes
Module I October 18-22, 2015 JW Marriott Marquis Hotel, Dubai, UAE
CME Accreditation is under process Module 1: Diabetes Facts and Diabetes in the Clinic Module 2: Nursing theory and educational (pedagogical) tools to advise and educate people with diabetes and their
University College Hospital. Sick day rules insulin pump therapy
University College Hospital Sick day rules insulin pump therapy Children and Young People s Diabetes Service Children whose diabetes is well controlled should not experience more illness or infections
MEDICAL COVERAGE POLICY. SERVICE: Insulin Pump and Continuous Glucose Monitoring. PRIOR AUTHORIZATION: Required. POLICY:
Important note Even though this policy may indicate that a particular service or supply may be considered covered, this conclusion is not based upon the terms of your particular benefit plan. Each benefit
Insulin Pump Therapy during Pregnancy and Birth
Approvals: Specialist Group: Miss F Ashworth, Dr I Gallen, Dr J Ahmed Maternity Guidelines Group: V1 Dec 2012 Directorate Board: V1 Jan 2013 Clinical Guidelines Subgroup: July 2011 MSLC: V1 Nov 2012 Equality
Reducing the risk of patient harm: A focus on insulin
Reducing the risk of patient harm: A focus on insulin New York State Partnership for Patients (NYSPFP) Initiative Regional Educational Session November 2013 1 1 Disclosure Matt Fricker, Matt Grissinger,
Improving Glycemic Control for Post-Operative Cardiac Surgery Patients: A Nurse Practitioner Led Project. Linda Kerr, DNP, RN, FNP-BC, CDE
Improving Glycemic Control for Post-Operative Cardiac Surgery Patients: A Nurse Practitioner Led Project Linda Kerr, DNP, RN, FNP-BC, CDE Problem Statement Hyperglycemia during the first 48 hours following
Hospital Guidelines: Inpatient Glycemic Management Guidelines
Hospital Guidelines: Inpatient Glycemic Management Guidelines Reviewed Date: 01/2012 Revision Date: 01/2012 Origination Date: 09/2011 Approved by: Date of Approval: Inpatient Glycemic Control Team 01/2012
A Simplified Approach to Initiating Insulin. 4. Not meeting glycemic goals with oral hypoglycemic agents or
A Simplified Approach to Initiating Insulin When to Start Insulin: 1. Fasting plasma glucose (FPG) levels >250 mg/dl or 2. Glycated hemoglobin (A1C) >10% or 3. Random plasma glucose consistently >300 mg/dl
Diabetes: When To Treat With Insulin and Treatment Goals
Diabetes: When To Treat With Insulin and Treatment Goals Lanita. S. White, Pharm.D. Director, UAMS 12 th Street Health and Wellness Center Assistant Professor of Pharmacy Practice, UAMS College of Pharmacy
British Columbia Pharmacy Association (BCPhA) Clinical Service Proposal Self-Monitoring of Blood Glucose in Type 2 Diabetes
British Columbia Pharmacy Association (BCPhA) Clinical Service Proposal Self-Monitoring of Blood Glucose in Type 2 Diabetes Introduction Self-monitoring of blood glucose (SMBG) is in widespread use among
Medical Policy Insulin Pumps
Medical Policy Insulin Pumps Document Number: 027 Authorization required Insulin Pumps & supplies Notification within 24 hours of service or next business day No Prior Authorization Not covered Pulsatile
CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus
CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing
Health Technology Appraisal- Continuous subcutaneous insulin infusion for the treatment of diabetes (review)
Health Technology Appraisal- Continuous subcutaneous insulin infusion for the treatment of diabetes (review) Submission on behalf of British Dietetic Association (BDA) Following consultation with the BDA
Improving the reporting of Medication Incidents. From Incident Reporting to Controls Assurance
Improving the reporting of Medication Incidents From Incident Reporting to Controls Assurance Quote Strive for perfection in everything you do. Take the best that exists and make it better. When it does
Electronic copy to all appropriate staff Intranet Notification in Staff Focus Related Trust Policies (to be read in conjunction with)
Diabetes Management for Children and Young People undergoing Surgery (0-16 yrs) Clinical Guideline Register No: 10096 Status: Public Developed in response to: Updated national guidelines Contributes to
Algorithms for Glycemic Management of Type 2 Diabetes
KENTUCKY DIABETES NETWORK, INC. Algorithms for Glycemic Management of Type 2 Diabetes The Diabetes Care Algorithms for Type 2 Diabetes included within this document are taken from the American Association
Health Professional s. Guide to INSULIN PUMP THERAPY
Health Professional s Guide to INSULIN PUMP THERAPY Table of Contents Introduction Presenting Insulin Pump Therapy to Your Patients When Your Patient Chooses the Pump Estimates for Starting Insulin Pump
THE STATISTICAL VARIANCE OF BLOOD GLUCOSE LEVELS OF MEDICIAL INTENSIVE CARE UNIT PATIENTS WHILE ON AN INSULIN INFUSION PROTOCOL
THE STATISTICAL VARIANCE OF BLOOD GLUCOSE LEVELS OF MEDICIAL INTENSIVE CARE UNIT PATIENTS WHILE ON AN INSULIN INFUSION PROTOCOL by Kimberly Lynn Ackerman A thesis submitted in partial fulfillment of the
Jane Jeffrie Seley DNP, MPH, GNP, CDE, BC-ADM, CDTC Diabetes Nurse Practitioner Division of Endocrinology NewYork-Presbyterian Hospital Weill Cornell
Jane Jeffrie Seley DNP, MPH, GNP, CDE, BC-ADM, CDTC Diabetes Nurse Practitioner Division of Endocrinology NewYork-Presbyterian Hospital Weill Cornell Medical College Disclosures Advisory Board Member:
Insulin Initiation and Intensification
Insulin Initiation and Intensification ANDREW S. RHINEHART, MD, FACP, CDE MEDICAL DIRECTOR AND DIABETOLOGIST JOHNSTON MEMORIAL DIABETES CARE CENTER Objectives Understand the pharmacodynamics and pharmacokinetics
EFFECT OF A. COMpUTERIzED INsULIN DOsE CALCULATOR ON. GLyCEMIC CONTROL. Critical Care Evaluation. 1.0 Hour
Critical Care Evaluation EFFECT OF A COMpUTERIzED INsULIN DOsE CALCULATOR ON ThE process OF GLyCEMIC CONTROL By Cheryl Dumont, RN, phd, CRNI, and Cheryl Bourguignon, RN, phd C E 1.0 Hour Notice to CE enrollees:
Self-Monitoring Of Blood Glucose (SMBG)
Self-Monitoring Of Blood Glucose (SMBG) Aim(s) and objective(s) It is important is to ensure that people with Diabetes are given the opportunity to self monitor their blood glucose appropriately as an
This guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital
CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS USING INSULIN PUMP THERAPY (Continuous Subcutaneous Insulin Infusion (CSII)), DURING ADMISSION TO HOSPITAL 1. Aim/Purpose of this
External Insulin Pumps Corporate Medical Policy
External Insulin Pumps Corporate Medical Policy File name: External Insulin Pumps File code: UM.DME.02 Origination: 4/2006 Last Review: 02/2014 (ICD-10 remediation only) Next Review: 10/2014 Effective
Chapter 21 Adjusting the Insulin Dosage and Thinking Scales
Chapter 21 Adjusting the Insulin Dosage and Thinking Scales BLOOD SUGAR GOALS (suggested ranges) It is our general goal to have blood sugar levels in the ranges listed below (also see Chapter 7). These
Using a Flow Sheet to Improve Performance in Treatment of Elderly Patients With Type 2 Diabetes
Special Series: AAFP Award-winning Research Papers Vol. 31, No. 5 331 Using a Flow Sheet to Improve Performance in Treatment of Elderly Patients With Type 2 Diabetes Gary Ruoff, MD; Lynn S. Gray, MD, MPH
Sponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational.
Clinical Trial Results Database Page 1 Sponsor Novartis Generic Drug Name Vildagliptin Therapeutic Area of Trial Type 2 diabetes Approved Indication Investigational Study Number CLAF237A2386 Title A single-center,
Policy For The Adjustment Of Insulin Dose For Patients With Diabetes By Diabetes Specialist Dietitians And Cystic Fibrosis Dietitians In NHS Grampian
Policy For The Adjustment Of Insulin Dose For Patients With Diabetes By Diabetes Specialist Dietitians And Cystic Fibrosis Dietitians In NHS Grampian Co-ordinators: Advanced Dietitian (Diabetes) Consultation
Australian Diabetes Society. Guidelines for Routine Glucose Control in Hospital
Australian Diabetes Society Guidelines for Routine Glucose Control in Hospital 2012 1 Contents Introduction Page 3 Section 1 Methodology and Process Page 5 Section 2 What glucose target should be aimed
The New Complex Patient. of Diabetes Clinical Programming
The New Complex Patient as Seen Through the Lens of Diabetes Clinical Programming 1 Valerie Garrett, M.D. Medical Director, Diabetes Center at Mission Health System Nov 6, 2014 Diabetes Health Burden High
Insulin Pump Therapy for Type 1 Diabetes
Insulin Pump Therapy for Type 1 Diabetes Aim(s) and objective(s) This guideline has been developed to describe which patients with Type 1 Diabetes should be referred for assessment for insulin pump therapy
Taking Insulin Pumps to School. Rachel Calendo, MS, RN, CPNP, CDE, Martha Cuevas, RN, BSN, CPT
Taking Insulin Pumps to School Rachel Calendo, MS, RN, CPNP, CDE, Martha Cuevas, RN, BSN, CPT Insulin Pumps Today A micro-computer, about the size of a pager Programmed to deliver both a preset amount
Overview. Provider Qualifications
Overview Diabetes self management training (DSMT) is a collaborative process through which patients with diabetes gain knowledge and skills needed to modify behavior and successfully manage the disease
The Economic Benefit of Public Funding of Insulin Pumps in. New Brunswick
The Economic Benefit of Public Funding of Insulin Pumps in New Brunswick Introduction Diabetes is a chronic, often debilitating and sometimes fatal disease, in which the body either cannot produce insulin
BOLUS INSULIN DOSAGES H. Peter Chase, MD and Erin Cobry, BS
CHAPTER 6: BOLUS INSULIN DOSAGES H. Peter Chase, MD and Erin Cobry, BS WHAT IS BOLUS INSULIN? Bolus insulin dosages refer to the quick bursts of insulin given to cover the carbohydrates in meals or snacks
Glycemic control in hospitalized patients with diabetes mellitus as a secondary diagnosis admitted to the medical floor of SOCH 7/2013 7/2014
Glycemic control in hospitalized patients with diabetes mellitus as a secondary diagnosis admitted to the medical floor of SOCH 7/2013 7/2014 Erlin J. Marte Introduction About 25% of patients with type
Medical Benefit Effective Date: 04/01/11 Next Review Date: 01/13 Preauthorization* Yes Review Dates: 07/07, 07/08, 07/09, 01/10, 01/11, 01/12
Continuous or Intermittent Monitoring of Glucose in Interstitial (10120) Medical Benefit Effective Date: 04/01/11 Next Review Date: 01/13 Preauthorization* Yes Review Dates: 07/07, 07/08, 07/09, 01/10,
Connect4 Patients CCCM Primary Care Community. Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM
Connect4 Patients CCCM Primary Care Community Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM September 17, 2015 Objectives: Describe innovative care management
Kaiser Sunnyside Medical Center Inpatient Pharmacy Manual
Page: 1 of 10 PURPOSE To provide a standard procedure for optimizing care of the inpatient with hyperglycemia and/or diabetes. Substantially provide safe and effective glucose control for all adult inpatients.
Saskatchewan Insulin Adjustment Module Page 2 May 2010
Saskatchewan Insulin Adjustment Module Page 2 Saskatchewan Insulin Adjustment Module Page 3 TABLE OF CONENTS Introduction... 5 Development Background... 5 Purpose... 5 Developing The Policies, Procedures
Challenges in Glycemic Control in Adult and Geriatric Patients. Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner
Challenges in Glycemic Control in Adult and Geriatric Patients Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner Provide an overview of diabetes prevalence; discuss challenges and barriers
2013 Diabetes Nursing Conference
2013 Diabetes Nursing Conference Focus on Self-Care Behaviors April 12, 2013 Mayo Clinic Mayo Continuing Nursing Education General Information Conference description and goals The incidence of diabetes
Ketones & diabetes; Reduce your risk!
Ketones & diabetes; Reduce your risk! Booklet includes Sick Day Wallet Card Ketones 101 Do I really need to know this? by Helen Jones RN, MSN, CSE YES! The word Ketone is important for you to know if you
MEDICAL POLICY POLICY TITLE DIABETIC SELF-MANAGEMENT TRAINING PROGRAM POLICY NUMBER MP- 2.076
Original Issue Date (Created): July 1, 2005 Most Recent Review Date (Revised): Effective Date: May 24, 2011 August 31, 2011- RETIRED I. POLICY Initial diabetic self-management training (DSMT) may be considered
DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES
One Children s Plaza Dayton, OH 45404-1815 www.childrensdayton.org DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended
Excellence in Care: Diabetes and Pregnancy
Excellence in Care: Diabetes and Pregnancy Laura Abbey RN, BSN, MA, CDE INDEPENDENT STUDY Health Professions Institute for Continuing Education Austin Community College The Austin Community College Health
Using the Flip Chart to Teach
Using the Flip Chart to Teach Learning Objectives: At the conclusion of this presentation, you should be able to: State being familiar and comfortable with the Diabetes Survival Skills Flip-Chart teaching
12/2/2011. Optimal Rehabilitation of the Cardiac Patient with Diabetes. Barbara Masters, BSN, RN-BC. Memorial Hospital Services.
Optimal Rehabilitation of the Cardiac Patient with Diabetes Barbara Masters, BSN, RN-BC Memorial Hospital Services Magnet accredited hospital April 2008 Acute Care Facility 316 Licensed beds Certified
Objectives. What Is Diabetes? 1/26/2015. Carbs & Meds & Meters, Oh My!: Diabetes in Pregnancy
Carbs & Meds & Meters, Oh My!: Diabetes in Pregnancy Jan Tisdale RD, MPH, CDE Nutritionist / Certified Diabetes Educator UAB School of Medicine OB/GYN Maternal-Fetal Medicine 02/2015 Objectives Review
Section 504 Plan (pg 1 of 8)
Section 504 Plan (pg 1 of 8) of Birth School Today s Section 504 Plan for: Disability: Diabetes School Year: Grade: Homeroom Teacher: Bus Number: Background Objectives The student has type diabetes. Diabetes
Medications and Diabetes
monitor track manage A TRUEinsight Guide manage Medications and Diabetes Understanding the Importance of Oral Medications The importance of oral medications Understanding the importance of oral medications
Diabetes Management Tube Feeding/Parenteral Nutrition Order Set (Adult)
Review Due Date: 2016 May PATIENT CARE ORDERS Weight (kg) Known Adverse Reactions or Intolerances DRUG No Yes (list) FOOD No Yes (list) LATEX No Yes ***See Suggestions for Management (on reverse)*** ***If
Description. Comprehensive Education Courses Take Control Now! (2 Hour Session Billed to Insurance)
The University of Maryland Diabetes Network offers the latest available therapies, clinical trials and custom tailored care plans just for you. Education is a key component to living with and managing
4/7/2015 CONFLICT OF INTEREST DISCLOSURE OBJECTIVES. Conflicts of Interest None Heather Rush. Heather M. Rush, APRN, CDE Louisville, KY
Heather M. Rush, APRN, CDE Louisville, KY CONFLICT OF INTEREST DISCLOSURE Conflicts of Interest None Heather Rush A conflict of interest exists when an individual is in a position to profit directly or
DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study
DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study National Diabetes Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What
Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines)
Cardiovascular Health Nova Scotia Guideline Update Nova Scotia Guidelines for Acute Coronary Syndromes (Updating the 2008 Diabetes sections of the Guidelines) Authors: Dr. M. Love, Kathy Harrigan Reviewers:
Medication errors are one of the most common causes
OUTCOMES IN PRACTICE Development and Implementation of a Standardized Sliding Scale Insulin Protocol Margaret H. Bahlinger, MS, RPh, and Kathryn A. Adkins, RN, BSN, CPHQ Medication errors are one of the
Numerous studies have demonstrated that utilization
DIABETES TECHNOLOGY & THERAPEUTICS Volume 18, Supplement 2, 2016 ª Mary Ann Liebert, Inc. DOI: 10.1089/dia.2015.0369 ORIGINAL ARTICLE Use of Glucose Rate of Change Arrows to Adjust Insulin Therapy Among
Managing the U Managing the U--500 500 Patient as a Surg as a Sur ical Inpatient
Managing the U-500 Patient as a Surgical Inpatient Tyler Fischback Pharmacy Specialist St. Clare Hospital I have no conflicts of interest to disclose The Case DM is a 37 y.o.. developmentally delayed T2DM
Insulin Pump Management and Continuous Glucose Monitoring Systems (CGMS)
Insulin Pump Management and Continuous Glucose Monitoring Systems (CGMS) Faith Daily, RN, BSN, CDE, CPT Certified Diabetes Educator/Insulin Pump Trainer August 16, 2014 Why Pump Therapy? Mimics normal
When and how to start insulin: strategies for success in type 2 diabetes
1 When and how to start insulin: strategies for success in type diabetes Treatment of type diabetes in 199: with each step treatment gets more complex Bruce H.R. Wolffenbuttel, MD PhD Professor of Endocrinology