This guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital

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1 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 Guideline This guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital 2. The Guidance What is insulin pump therapy? Insulin pumps are used by people with Type 1 diabetes. Rapid-acting insulin is infused by a battery driven pump via an infusion set, which is usually inserted into the abdomen. Rapid or short acting insulin is infused continuously (Basal insulin). This rate is preprogrammed and can be adjusted by the person using the pump. Bolus doses of insulin are given by pressing a button whenever food (carbohydrate) is consumed. General Pump Management Patients using insulin pump therapy have been educated /trained to manage their diabetes and their pump Patients using pump therapy have a continuous supply of background insulin and therefore do not have to eat at set times. Fasting is not a problem for pump users, however specific advice may be required for dose adjustments: (contact pump Diabetes Specialist Nurses ) Insulin pumps should not be discontinued without either: - Commencing Intravenous Sliding Scale insulin (at which time insulin should be stopped) or - Administering long acting insulin (Levemir, Lantus, Tresiba) at least 6 prior to stopping Patients admitted to hospital should continue to manage their diabetes using their pump except: o If unconscious o Illness prevents self-management o Major surgery o Diabetic Ketoacidosis (DKA) If a surgical procedure is planned, please advise the patient to liaise with the pump diabetes nurse specialists ( ) at pre-assessment for specific advice Useful 24 hour 7 day/week Company insulin pump help-lines: Accu-Chek Animas Page 1 of 7

2 Is the patient using an insulin pump Ensure usual insulin / diabetes medications are prescribed on EPMA Is the patient Hypoglycaemic Blood Glucose < 4 mmol/l Follow the hospital guideline for the management of hypoglcyaemia Is the patient conscious and orientated? Has the patient been admitted with Diabetic Ketoacidosis Follow Diabetic Ketoacidosis Guideline (See hospital guideline) Has the patient been admitted for major surgery The patient can NOT self manage their insulin pump 1. Do not cut the infusion set 2. Remove the infusion set from the abdomen. 3. Immediately commence Intravenous sliding scale insulin infusion (See Hospital Guideline) 4. Place the pump in a safe place and document 5. Inform the DISN team (bleep 2205, #3104) and or the Endocrine Team 1. Follow pre op assessment plan from Pump Specialist Nurse 2.Inform DISN team (bleep 2205, #3104) and or the Endocrine Team of admission The patient can self manage their insulin pump 1. Complete the registered nurse assessment form for self administration 2. Insulin pump must be prescribed on EPMA 3. Inform DISN team 2205, #3014 and or the Endocrine Team of admission Page 2 of 7

3 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Compliance with the relevant process for patients seen at a Diabetes Team Review. Specialist Adult In-Patient Diabetes Team Patient Documentation Adult in-patients with diabetes who use Insulin Pump Therapy and who are reviewed by the specialist diabetes team n compliance will be reported to the responsible, ward manager. n compliance resulting in an adverse patient event will be reported via Datix Ward managers will undertake subsequent recommendations and action planning for any or all deficiencies and recommendations within reasonable timeframes for their areas The Specialist Adult In-Patient Diabetes Team will undertake any trust wide recommendations and action planning for any or all deficiencies and recommendations within reasonable timeframes Change in practice and lessons to be shared Lesson learned or changes to practice will be shared with all the relevant stakeholders 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement which can be found in the 'Equality, Diversity & Human Rights Policy' or the Equality and Diversity website Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 3 of 7

4 Appendix 1. Governance Information Document Title Clinical Guideline for the management of adults with diabetes mellitus using insulin pump therapy when admitted to hospital Date Issued/Approved: Date Valid From: Date for Review: May 2017 Directorate / Department responsible (author/owner): Contact details: Medical Directorate Amanda Veall Lead Clinical Nurse Specialist Diabetes Helen Chenoweth Pump Clinical Nurse Specialist Diabetes Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Clinical Guideline for the management of adults with diabetes mellitus using insulin pump therapy when admitted to hospital Diabetes and Surgery RCHT PCT CFT Medical Director Governance Diabetes In-Patient Specialist Nurses, Diabetes Pump Specialist, Nurse Consultant Endocrinologists, Stella Ellis Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder t Required {Original Copy Signed} Internet & Intranet Diabetes Intranet Only Links to key external standards DoH:NSF Diabetes 2001 standard 8 Related Documents: NHS Diabetes Self-Management of diabetes in hospital March 2012 Page 4 of 7

5 Training Need Identified? Version Control Table Date Version Summary of Changes Changes Made by (Name and Job Title) Initial Version written A Veall All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager Page 5 of 7

6 Appendix 2.Initial Equality Impact Assessment Screening Form Name of service, strategy, policy or project (hereafter referred to as policy) to be assessed: CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS USING INSULIN PUMP THERAPY WHEN ADMITTED TO HOSPTIAL Directorate and service area:medicine Existing Procedure Name of individual completing Amanda Veall Telephone: 3104 assessment: 1. Policy Aim* To provide detailed guidance on the clinical management of Adults with Diabetes using insulin pump therapy when admitted to hospital 2. Policy Objectives* To provide a consistent approach to the management of Diabetes for Adults admitted to hospital using insulin pump therapy To maintain patient safety and improve outcomes for adult patients with Diabetes admitted to hospital using insulin pump therapy 3. Policy intended Consistent management of Diabetes at RCHT sites. Outcomes* Prompt and safe management of Diabetes for Adults 4. How will you measure the outcome? 5. Who is intended to benefit from the Policy? 6a. Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? using insulin pump therapy when admitted to hospital Audit Datix Reporting Review of surgical / nursing documentation as required All adult patients with diabetes using insulin pump therapy when they are admitted to hospital b. If yes, have these groups been consulted? c. Please list any groups who have been consulted about this procedure. Diabetes Inpatient Specialist Nurses Diabetes Pump Specialist Nurse Consultant Endocrinologists 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Rationale for Assessment / Existing Evidence Age Page 6 of 7

7 Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked in any column above and consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. A summary of the results will be published on the Trust s web site. Signed Amanda Veall Date Page 7 of 7

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