SHINE Study Ordering Instructions for Investigators SUNY Downstate
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1 General Directions SHINE Study Ordering Instructions for Investigators SUNY Downstate 1) Call Spiro Demetis to get patient admitted to ICU ASAP. Cell: ; Pager: Let him know that this is a SHINE study patient that needs a bed urgently. 2) Make sure that the patient gets registered in Eagle (orders in ER Holding NOT Outpatient). Call admitting to check on status/progress : (718) ) Please call the pharmacy to let them know that you will be ordering SHINE study drugs for a patient (give name and MRN) a. During regular business hours, call Motria at x4340. b. All other times, call the main pharmacy at x2854 or x2856 4) Please determine if patient has been cleared to eat or if patient remains NPO. 5) Please fax a copy of the randomization confirmation to pharmacy& copy of the consent (Motria x8192 or Main x2855) or bring it to the pharmacy. 6) Please be sure to order a SHINE Diet for either group(instructions below). General Ordering Instructions: **All study drug ordering is done in HEALTHBRIDGE so patient must be admitted before drug can be ordered!!! 1) Login to HealthBridge, and select the prescription writer. 2) Utilize the search box to locate the appropriate drugs below. Ordering Instructions for Control Group (ORANGE) 1) OrderingIV Saline Infusion: Drug: Normal Saline Infusion No Additive 250 ml x 1 dose Medication Dispensing Source: Pharmacy Route: IV Drip Rate: 0.01 ml/hr (dummy dose) Frequency: Continuous Duration: 24 hours ( Pharmacy will adjust duration to 72 hrs upon order verification) Note to Pharmacy field: SHINE Study order Nurse Instructions field: Rate adjustments based upon POC FS blood glucose measurements and protocol sliding scale (4 ml/hr for BG mg/dl or 5 ml/hr for BG 180 mg/dl). Discontinue if BG < 80 mg/dl and start SHINE hypoglycemia protocol.
2 2) Ordering Insulin Injections:*Please note: Re-order daily so that Level can be confirmed. Drug: Insulin Regular Injectable Start Date: Date of first dose Start Time: Select Routine Dose: 0.01 Units (dummy dose) UOM: Units Frequency: Select User schedule option from drop down menu. Click on box to the right of this field. Select time 06:00 and click Add. Do the same for the other times (12:00, 18:00, 00:00) then click OK. Note to Pharmacy field: SHINE Study order, Nurse Instructions field: Select the sliding scale (below) for the level patient is at then copy & paste scale into field. Prescriber can delete the existing note that is preconfigured in the Nurse Instructions field since it would not apply to these patients. Glucose (mg/dl) level 1 (units) > Glucose (mg/dl) level 2 (if 2 prev BG levels 180) >
3 Glucose (mg/dl) level 3 (if 2 prev BG still 180) And administer Glargine x 1 dose > ) Ordering Glargine*: Drug: Insulin Glargine Injectable Start Time: Select Time Critical ; put in 48 hour (from randomization) time point. Dose: 40% of previous day s entire insulin dose (must be numeric) UOM: Units Frequency: Once Instructions: If 2 previous BG 180 mg/dl on level 2 dose of regular insulin, give 40% of previous day s entire insulin dose x 1 SQ at 48 hour point of study and continue level 3 regular insulin dosing. Cut & paste in Note to Pharmacy field: SHINE Study order 4) Ordering Dextrose 50%: Drug: Dextrose 50% IV Dose: 12.5 grams UOM: grams Route: IV Push Frequency: PRN (check PRN box and select Every 15 minutes in frequency field) Note to Pharmacy field: SHINE Study order Nurse Instructions field: Q15minutes until FS BG 80 mg/dl.
4 Instructions for Intervention Group (Blue) 1) Ordering Insulin Infusion: Drug: Insulin Regular Drip 250 u/250 ml Rate: 0.01 ml/hr (dummy dose) Medication Dispensing Source: Pharmacy UOM: ml/hr Route: IV Drip Frequency: Continuous Duration: 24 hours ( Pharmacy will adjust duration to 72 hrs upon order verification) Note to Pharmacy field: SHINE Study order Nurse Instructions field: Adjust rate per Glucostablizer recommendations at BG check times. Discontinue if BG < 80 mg/dl and start SHINE hypoglycemia protocol. (Prescriber can delete existing note that is preconfigured in the Nurse Instructions field since it would not apply to these patients.) 2) Ordering Normal Saline Injections**: Order Non-formulary medication request. This right is assigned to attending physicians ONLY. Any prescriber who does not have attending credentials in HealthBridge cannot enter/discontinue NF freetext orders. NF free-text orders entered by residents/fellows do not cross over to the pharmacy verification screen nor are they viewable by Pharmacy. In this case, either an attending shall enter these orders electronically in HB or the resident/fellow shall write a paper order (include the attending s name after they ve signed the order) and fax to Pharmacy x2855. Call Pharmacy to reenter the order on behalf of the attending, Motria 9-5 M-F x4340; all other hours Main Pharm x2856, x2854, or x6143 Medication Name field: Enter Normal Saline (Floor Stock 10 ml vial) Start Time: Routine Medication Dispensing Source Field: Select Pharmacy. Inform nurse to take from floorstock even though order indicates dispensing source as Pharmacy. Non-formulary Reason field: SHINE Study Dose: 0.05 ml Frequency: BID at 09:00 and 21:00 (BID dosing defaults to 10 AM and 6 PM. The time specified 09:00 and 21:00 are 12hrs apart. For specific dosing time, select user schedule in the drop down menu of the frequency field. A box will appear to the left once user schedule is selected. Click on box to the left of the field and select 09:00 then click Add. Next select 21:00 and click Add to include these 2 times in the order.
5 Note to Pharmacy field: SHINE Study order Nurse Instructions field If subject NPO or receiving continuous tube feeds, give 0.05 ml NS with BG checks closest to 09:00 and 21:00 3) Ordering Insulin Aspart Injections**: Drug: Insulin Aspart Injectable Dose: 0.01 Units (dummy dose) Frequency: TID with meals Note to Pharmacy field: SHINE Study order. Nurse Instructions field: Dose based on meal consumption of 60 g carb meal. Dose will be supplied by Glucostabilizer. Prescriber can delete existing note that is preconfigured in the field since it would not apply to these patients. 4) Ordering Dextrose 50%: Drug: Dextrose 50% IV Dose: 0.01 gram (dummy dose) Route: IV Push Frequency: Q15minutes PRN (check PRN box then select Every 15 minutes in the frequency field) Note to Pharmacy field: SHINE Study order. Nurse Instructions: Follow SHINE hypoglycemia protocol for BG < 80 mg/dl. Dose according to Glucostabilizer recommendations. Ordering Instructions for SHINE Diet 1) Select the Regular Diet. 2) In the ordering instructions, please type, SHINE Protocol Diet, 60 gram Carbohydrates/meal 3) Please make sure you choose an end date so that it ends once the 72 hours are over.
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