/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/cpg/,/clinical/cckm-tools/content/cpg/npg/,

/clinical/cckm-tools/content/cpg/npg/name-117163-en.cckm

201706152

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Nursing Practice Guidelines

Insulin Pump Use in Hospital Settings Guideline at a Glance (Nursing Practice Guideline)

Insulin Pump Use in Hospital Settings Guideline at a Glance (Nursing Practice Guideline) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Nursing Practice Guidelines


Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
1
Guideline Title: Insulin Pump Use in Hospital Settings Nursing Practice Guideline
Effective Date: January 2017
Approved By: Nursing Practice Guidelines Committee; Nursing Practice Council
I. Guideline Overview
Target Population
Hospitalized adult and pediatric patients using their own insulin pumps
Nursing Practice Guideline Objectives
To describe best practices surrounding the nursing care of patients using their own insulin pumps
(continuous subcutaneous insulin infusions) while hospitalized. Specifically, this guideline addresses:
ξ Organizational needs
ξ Assessment
ξ Documentation
ξ Management
ξ Education
Clinical Question(s) Considered
What strategies should be used to ensure patient safety when caring for patients using their own insulin
pumps while hospitalized?
For more information, please see the complete guideline
II. Practice Recommendations
For more information about rating scheme used to describe strength of recommendations, see below.
Organizational Needs
1. A policy should be in place to promote safe care for those patients who maintain the use of their own insulin
pumps during hospitalization. 2,4,6,8-11,13,15,16,20-22
2. Criteria for insulin pump use during acute and critical illness should be established and included in an
organization’s policy requirements. 1,9,11,16,18
3. Provider orders should be given for insulin pump use while the patient is hospitalized. 9,11,13-17

Assessment
4. A knowledge assessment should be completed to determine competency of the patient (or
parent/guardian/significant other managing the pump for the patient) to manage his/her pump when acutely
ill.
7,11,14-17
5. The patient’s competence for using a pump during a cute illness should be re-assessed if/when his/her
clinical condition changes. 11,16
Recommended for Practice
Likely to Be Effective
University of Wisconsin Hospitals and Clinics
Nursing Practice Guideline At-a-Glance

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
2
6. The insulin pump infusion site should be assessed at least daily and more often during episodes of
hyperglycemia, or for patients who have a history of skin infections, a llergic reactions, and/or when there
are concerns about infusion catheter patency or dislodgement. 11,16,22
Documentation
7. Documentation should be completed according to organizational policies to include competency assessment,
patient-administered basal and bolus insulin doses, glucose monitoring results, infusion site assessment
including when site is changed (usually every 72 hours at minimum), and a signed patient agreement to use
an insulin pump in a hospital setting.2,4, 7-11,13-18,22
Management
8. Target glucose goals should be individualized taking into consideration patient preference and established
best practice recommendations for glycemic control during hospitalization. 4
9. Insulin pumps should not be used during episodes of diabetic ketoacidosis and hyperosmolar hyperglycemic
state (DKA/HHS).9,11,13,15,19
10. Insulin pump should not be used during procedures or surgery involving radiation or magnetic fields. Pumps
must be removed and placed outside of the testing field.6,9,11,15-17
11. Patients undergoing a procedure or surgery that is less than 1-2 hours may be able to safely continue insulin
pump use.6,11,14,15,20
12. Alternative insulin delivery methods (intravenous or basal-bolus injections) should be instituted in the
following situations:
o Critical illness
o patient assessed to be incompetent or unable to independently manage insulin pump,
o persistent hyperglycemia (including diabetic ketoacidosis or hyperosmolar hyperglycemic
syndrome) and hypoglycemia, and/or
o insulin pump interruption or removal for time period of 1-2 hours or more.1,7,11,14-17,23
13. Diabetes specialty providers such as certified diabetes educators (CDEs), clinical dietitians, and hospital -
based diabetes management teams should be consulted in the care of patients admitted with insu lin
pumps.8-11,13,15,17,18,23
Education
14. Comprehensive pump training is ideally accomplished in an outpatient setting when patients are in their
usual state of health. Initiating pump training when patients are acutely ill is not recommended.2
15. Patients with identified knowledge deficits should be referred to diabetes pump specialists for additional
education as an outpatient.1,2,10
16. Clinical staff should have education and/or clinical practice resources available specific to how to care for
patients who maintain the use of their insulin pumps in the hospital setting.6,9,11,22
III. Pertinent Resources
A. Policies
ξ UW Health Clinical Policy 2.3.19: Subcutaneous Insulin Pump (Patient’s Own) and Continuous
Glucose Monitor Use in the Hospital Setting
B. Patient Education Resources
ξ Health Facts for You #7012: Using Your Insulin Pump in the Hospital
ξ Health Facts for You #6979: Problem Solving High Blood Sugars When Using an Insulin Pump
ξ Health Facts for You #7948: Insulin Pump Requirements

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
3
ξ Health Facts for You #7949: Pathway to Insulin Pump Therapy
C. Clinical Tools
1. Other Insulin Pump Resources (U-Connect: Inpatient Diabetes Management page)
2. Caring for Patients with Insulin Pumps: What Every Nurse Needs to Know
3. Assessment Guide for Insulin Pump Self-Administration Competency
4. Other Insulin Pump Resources
IV. References
See full guideline document for complete list of references
V. Rating Scheme For The Strength Of The Recommendations
Category Description
Recommended
for Practice:
Interventions for which effectiveness has been demonstrated by strong evidence
from rigorously designed studies, meta-analysis, or systematic reviews, and for
which expectation of harm is small compared to the benefits.
Likely to be
Effective:
Interventions for which effectiveness has been demonstrated from single rigorously
conducted controlled trial, consistent supportive evidence from well-designed
controlled trials using small samples, or guidelines developed from evidence and
supported by expert opinion.
Benefits
Balanced with
Harm:
Interventions for which clinicians and patients should weigh the beneficial and
harmful effects according to individual circumstances and priorities.
Effectiveness
Not
Established:
Interventions for which insufficient or conflicting data or data of inadequate quality
currently exist, with no clear indication of harm.
Effectiveness
Unlikely:
Interventions for which lack of effectiveness has been demonstrated by negative
evidence from a single rigorously conducted controlled trial, consistent negative
evidence from well-designed controlled trials using small samples, or guidelines
developed from evidence and supported by expert opinion.
Not
recommended
for Practice:
Interventions for which lack of effectiveness or harmfulness has been demonstrated
by strong evidence from rigorously conducted studies, meta-analyses, or systematic
reviews, or interventions where the costs, burden, or harm associated with the
intervention exceed anticipated benefit.

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
4
NURSING PRACTICE GUIDELINE SCOPE
Disease/Condition(s)
Diabetes mellitus
Intended Users
ξ Registered Nurses
ξ Any direct care nurses who care for this patient population
Target Population
Hospitalized adult and pediatric patients using their own insulin pumps
Nursing Practice Guideline Objective(s)
To describe best practices surrounding the nursing care of patients using their own
insulin pumps (continuous subcutaneous insulin infusions) while hospitalized.
Specifically, this guideline addresses:
ξ Organizational needs
ξ Assessment
ξ Documentation
ξ Management
ξ Education
Clinical Question(s) Considered
What strategies should be used to ensure patient safety when caring for patients using
their own insulin pumps while hospitalized?
University of Wisconsin
Hospitals and Clinics
Nursing Practice Guidelines
Insulin Pump Use
in Hospital
Settings
January 2017

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
5
Major Outcomes Considered
Registered Nurses have evidence-based resources to provide high quality, safe care for
patients who maintain the use of their own insulin pumps while hospitalized.
METHODOLOGY
Description Of Methods Used To Collect/Select the Evidence
The literature search began with a search for external, pre-existing guidelines specific to the
nursing care of patients who maintain the use of their insulin pump in the hospital. No guideline
exists that met this specific population. In a search for individual studies to gu ide practice
recommendation development, the clinical expert on the development group conducted a
literature review in both PubMed and CINAHL using search terms of insulin, insulin pump,
diabetes, continuous subcutaneous insulin infusion, hospital, and inpatient for publication dates
from 2011 - current. Hand searches of references were also conducted. Studies were narrowed
to 23 relevant articles.
Methods Used To Assess The Quality And Strength Of The Evidence
The following rating scheme was utilized to identify to strength of each individual study.
Rating Scheme For The Strength Of The Evidence
Strongest (I) ± Weakest (VII) as follows:
I
A systematic review of meta-analysis of all relevant Randomized Clinical
Trials (RCT) or Evidence Based Practice (EBP) Clinical Guidelines on
systematic reviews of RCTs
II At least one properly designed RCT of appropriate size
III Well designed trials without randomization
IV Well designed single group pre-post cohort, time series, or matched
case-control studies
V Systematic review of well-designed descriptive and qualitative studies
VI Single experimental, quasi-experimental, non-experimental (descriptive
or qualitative) study
VII Opinion of respected authorities, based on clinical evidence, descriptive
studies or reports of expert committees.
Description Of Methods Used To Formulate The Recommendations

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
6
Guideline recommendations were drafted by the content expert using the table of
evidence and addressed organizational needs, assessment, documentation,
management, and education. These recommendations were reviewed, modified, and
endorsed by unit-based adult and pediatric diabetes resource nurses. Members of the
guideline development group provided a final review and consensus validation of the
evidence and recommendations.
Rating Scheme For The Strength Of The Recommendations
Category Description
Recommended
for Practice:
Interventions for which effectiveness has been demonstrated by
strong evidence from rigorously designed studies, meta-analysis, or
systematic reviews, and for which expectation of harm is small
compared to the benefits.
Likely to be
Effective:
Interventions for which effectiveness has been demonstrated from
single rigorously conducted controlled trial, consistent supportive
evidence from well-designed controlled trials using small samples, or
guidelines developed from evidence and supported by expert opinion.
Benefits
Balanced with
Harm:
Interventions for which clinicians and patients should weigh the
beneficial and harmful effects according to individual circumstances
and priorities.
Effectiveness
Not Established:
Interventions for which insufficient or conflicting data or data of
inadequate quality currently exist, with no clear indication of harm.
Effectiveness
Unlikely:
Interventions for which lack of effectiveness has been demonstrated
by negative evidence from a single rigorously conducted controlled
trial, consistent negative evidence from well-designed controlled trials
using small samples, or guidelines developed from evidence and
supported by expert opinion.
Not
recommended
for Practice:
Interventions for which lack of effectiveness or harmfulness has been
demonstrated by strong evidence from rigorously conducted studies,
meta-analyses, or systematic reviews, or interventions where the
costs, burden, or harm associated with the intervention exceed
anticipated benefit.
Description Of Method Of Guideline Validation
Content of this guideline has been validated by the adult and pediatric Diabetes
Resource Nurses at the University of Wisconsin Hospitals & Clinics. Additionally,
external reviewers representing non-nursing disciplines in adult and pediatric practice
areas provided feedback on the guideline to ensure content validity. The Nursing
Practice Guideline Committee and Nursing Practice Council reviewed and approved the
guideline.

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
7
INTRODUCTION
Continuous subcutaneous insulin infusions or insulin pumps, are designed for
outpatient/home use. Experts agree that insulin pump use can be safely used in hospital
settings,4,5,8,12,21,22 but there is limited evidence in the literature about how to care for these
patients to ensure safe outcomes. An estimated 400,000 Americans with type 1 diabetes are
using pumps according to the most current data.12 The use of insulin pumps by those with all
types of diabetes is growing. Naturally, the prevalence of patients using insulin pumps in
acute/critical care settings is likely to rise as well.
The annually updated American Diabetes Association (ADA) Clinical Practice
Recommendations4 provide little guidance about insulin pump usage when patients are
hospitalized. The ADA position statement Continuous Subcutaneous Insulin In fusion3 does
not address the topic. A recently published white paper from the American Association of
Diabetes Educators2 briefly addresses safe practices related to pump use in hospital
settings. This guideline, Insulin Pump Use in Hospital Settings, is intended to supplement
the aforementioned publications by describing best practices surrounding the nursing care
of adult and pediatric patients who maintain the use of their own insulin pumps while
hospitalized.
This Nursing Practice Guideline is a revision of the 2014 guideline by the same name. This
topic was chosen based on discussion with content experts, the guideline development
group, and members of the Nursing Practice Council at the University of Wisconsin Hospital
and Clinics.
RECOMMENDATIONS
Organizational Needs
1. A policy should be in place to promote safe care for those patients who maintain the use of
their own insulin pumps during hospitalization.2,4,6,8-11,13,15,16,20-22
o Insulin pump policies should address the following:
 determinants of continuing (and discontinuing) pump use,
 strategies to address interruption in insulin infusion,
 patient assessment requirements,
 documentation requirements,
 care practices for pump patients going to surgery, and
 care practices for pump patients requiring procedures and/or surgery
involving radiation or magnetic fields.
2. Criteria for insulin pump use during acute and critical illness should be established and
LQFOXGHG�LQ�DQ�RUJDQL]DWLRQ¶V�SROLF\�UHTXLUHPHQWV.1,9,11,16,18
Recommended for Practice

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
8
o Criteria to consider include the following:
 Competency to use pump independently
 Cognitive/mental status
 Physiologic factors (i.e., efficacy of subcutaneous insulin administration
during illness due to vasoconstriction)
 Persistent or recurrent hypoglycemia or hyperglycemia
 Admitting diagnosis of diabetic ketoacidosis/ hyperosmolar hyperglycemic
state (DKA/HHS)
 Physical capabilities
 Visual capabilities
 Risk of self-harm including suicidal ideation
 Mechanical integrity of pump
 Availability of pump supplies
3. Provider orders should be given for insulin pump use while the patient is hospitalized .9,11,13-
17
o Orders should include but are not limited to the following:
 self-administration of insulin,
 type of insulin used in the pump,
 basal rates with associated administration times,
 insulin/carbohydrate ratios or set doses for meal coverage,
 sensitivity/ correction factor(s) for hyperglycemia,
 hypoglycemia treatment,
 timing/frequency of blood glucose testing with hospital meter,
 target blood glucose goal, and
 provider notification parameters about hypoglycemia and hyperglycemia.
Assessment
4. A knowledge assessment should be completed to determine competency of the patient (or
parent/guardian/significant other managing the pump for the patient) to manage his/her
pump when acutely ill.7,11,14-17
5. 7KH�SDWLHQW¶V�FRPSHWHQFH�IRU�XVLQJ�D�SXPS�GXULQJ�DFXWH�LOOQHVV�VKRXOG�EH�re-assessed
if/when his/her clinical condition changes.11,16
6. The insulin pump infusion site should be assessed at least daily and more often during
episodes of hyperglycemia, or for patients who have a history of skin infections, allergic
reactions, and/or when there are concerns about infusion catheter patency or
dislodgement.11,16,22
Likely to be Effective

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
9
Documentation
7. Documentation should be completed according to organizational policies to include
competency assessment, patient-administered basal and bolus insulin doses, glucose
monitoring results, infusion site assessment including when site is changed (usually every
72 hours at minimum), and a signed patient agreement to use an insulin pump in a
hospital setting.2,4,7-11,13-18,22
Management
8. Target glucose goals should be individualized taking into consideration patient preference
and established best practice recommendations for glycemic control during
hospitalization.4
9. Insulin pumps should not be used during episodes of diabetic ketoacidosis and
hyperosmolar hyperglycemic state (DKA/HHS).9,11,13,15,19
10. Insulin pump should not be used during procedures or surgery involving radiation or
magnetic fields. Pumps must be removed and placed outside of the testing field.6,9,11,15-17
11. Patients undergoing a procedure or surgery that is less than 1-2 hours may be able to
safely continue insulin pump use.6,11,14,15,20
12. Alternative insulin delivery methods (intravenous or basal-bolus injections) should be
instituted in the following situations:
o Critical illness
o patient assessed to be incompetent or unable to independently manage insulin
pump,
o persistent hyperglycemia (including diabetic ketoacidosis or hyperosmolar
hyperglycemic syndrome) and hypoglycemia, and/or
o insulin pump interruption or removal for time period of 1-2 hours or more.1,7,11,14-17,23
13. Diabetes specialty providers such as certified diabetes educators (CDEs), clinical
dietitians, and hospital-based diabetes management teams should be consulted in the
care of patients admitted with insulin pumps.8-11,13,15,17,18,23
Education
14. Comprehensive pump training is ideally accomplished in an outpatient setting when
patients are in their usual state of health. Initiating pump training when patients are acutely
ill is not recommended.2
15. Patients with identified knowledge deficits should be referred to diabetes pump specialists
for additional education as an outpatient.1,2,10

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
10
16. Clinical staff should have education and/or clinical practice resources available specific to
how to care for patients who maintain the use of their insulin pumps in the hospital
setting.6,9,11,22
Companion Documents and Resources
ξ UW Health Clinical Policy 2.3.19��6XEFXWDQHRXV�,QVXOLQ�3XPS��3DWLHQW¶V�2ZQ��DQG
Continuous Glucose Monitor Use in the Hospital Setting
ξ Caring for Patients with Insulin Pumps: What Every Nurse Needs to Know
ξ Assessment Guide for Insulin Pump Self-Administration Competency
ξ Other Insulin Pump Resources
Availability Of Companion Documents
U-Connect, Nursing Practice Guidelines webpage will link to available resources and
companion documents.
Patient Resources
ξ Health Facts for You #7012: Using Your Insulin Pump in the Hospital
ξ Health Facts for You #6979: Problem Solving High Blood Sugars When Using an
Insulin Pump
ξ Health Facts for You #7948: Insulin Pump Requirements
ξ Health Facts for You #7949: Pathway to Insulin Pump Therapy
References Supporting the Recommendations
NOTE: Level of evidence appears after the reference.
1. Amer Assoc Diabet, E. (2011). Insulin pump therapy: Best practices in choosing and
using infusion devices. VII
2. Amer Assoc Diabet, E. (2014, June 6). White paper: Continuous subcutaneous
insulin infusion. VII
3. Association, A. D. (2004). Continuous subcutaneous insulin infusion. Diabetes Care,
27 (Suppl 1), S110. VII
4. Association, A. D. (2017). Standards of medical care in diabetes²2017. Diabetes
Care, 40(Supplement 1), S14-S80. doi: 10.2337/dc14-S014 I
5. Bailon, R. M., Partlow, B. J., Miller-Cage, V., Boyle, M. E., Castro, J. C., Bourgeois,
P. B., & Cook, C. B. (2009). Continuous subcutaneous insulin infusion (insulin
pump) therapy can be safely used in the hospital in select patients. Endocrine
Practice, 15(1), 24-29. doi: 10.4158/EP.15.1.24 IV
6. Boyle, M. E., Seifert, K. M., Beer, K. A., Apsey, H. A., Nassar, A. A., Littman, S. D., .
. . Cook, C. B. (2012). Guidelines for application of continuous subcutaneous insulin
infusion (insulin pump) therapy in the perioperative period. J Diabetes Sci Technol,
6(1), 184-190. VII

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
11
7. Buchko, B. L., Artz, B., Dayhoff, S., & March, K. S. (2012). Improving care of
patients with insulin pumps during hospitalization: Translating the evidence. J Nurs
Care Qual, 27(4), 333-340. doi: 10.1097/NCQ.0b013e3182595881 VII
8. Cook, C. B., Beer, K. A., Seifert, K. M., Boyle, M. E., Mackey, P. A., & Castro, J. C.
(2012). Transitioning insulin pump therapy from the outpatient to the inpatient
setting: a review of 6 years' experience with 253 cases. J Diabetes Sci Technol,
6(5), 995-1002. IV
9. Cook, C. B., Beer, K. A., Seifert, K. M., Boyle, M. E., Mackey, P. A., & Castro, J. C.
(2012). Transitioning insulin pump therapy from the outpatient to the inpatient setting:
a review of 6 years' experience with 253 cases. J Diabetes Sci Technol , 6(5), 995-
1002. IV
10.Cook, C. B., Boyle, M. E., Cisar, N. S., Miller-Cage, V., Bourgeois, P., Roust, L. R., .
. . Zimmerman, R. S. (2005). Use of continuous subcutaneous insulin infusion
(insulin pump) therapy in the hospital setting - Proposed guidelines and outcome
measures. Diabetes Educator, 31(6), 849-857. doi: 10.1177/0145721705281563 VII
11.Grunberger, G., Bailey, T. S., Cohen, A. J., Flood, T. M., Handelsman, Y., Hellman,
R., . . . Management, A. I. P. (2010). Statement by the American Association of
Clinical Endocrinologists consensus panel on insulin pump management. Endocrine
Practice, 16(5), 746-762. VII
12. Institute for Safe Medicine Practices (ISMP) (2016, October 20). Guidelines for the
safe management of patients with an external subcutaneous insulin pump during
hospitalization. Acute care ISMP Medication Safety Alert, 21(21), 3-7. Retrieved
from https://www.ismp.org/newsletters/acutecare/showarticle.aspx?id=1151 VII
13.Juvenile Diabetes Research Foundation (2010). JDRF and BD Collaborate to
Improve Insulin Pump Delivery.
https://www.bd.com/infusionset/pdfs/BD_JDRF_press_release_2010.pdf VII
14.Klonoff, D. C., & Reyes, J. S. (2009). Insulin pump safety meeting: Summary report.
Journal of diabetes science and technology, 3(2), 396-402. VII
15.Lansang, M. C., Modic, M. B., Sauvey, R., Lock, P., Ross, D., Combs, P., &
Kennedy, L. (2013). Approach to the adult hospitalized patient on an insulin pump.
Journal of Hospital Medicine, 8(12), 721-727. doi:10.1002/jhm.2109 VII
16.Mackey, P. A., Thompson, B. M., Boyle, M. E., Apsey, H. A., Seifert, K. M.,
Schlinkert, R. T., . . . Cook, C. B. (2015). Update on a quality initiative to standardize
perioperative care for continuous subcutaneous insulin infusion therapy. J Diabetes
Sci Technol, 9(6), 1299-1306. doi:10.1177/1932296815592027 VII
17.McCrea, D. (2013). Management of the hospitalized diabetes patient with an insulin
pump. Crit Care Nurs Clin North Am, 25(1), 111-121. doi:
10.1016/j.ccell.2012.11.010 VII
18.Miller, D. (2009). Are you ready to care for a patient with an insulin pump? Nursing,
39(10), 57-60. VII
19.Moghissi, E. S., Korytkowski, M. T., DiNardo, M., Einhorn, D., Hellman, R., Hirsch, I.
B., . . . Umpierrez, G. E. (2009). American Association of Clinical Endocrinologists
and American Diabetes Association Consensus Statement on Inpatient Glycemic
Control. Diabetes care, 32(6), 1119-1131. doi: 10.2337/dc09-9029 VII

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
12
20.Mu, Y., & Yin, S. (2012). Insulin pump therapy guidelines for China (July 2010).
Journal of Diabetes, 4(2), 127-139. doi:10.1111/j.1753-0407.2011.00174.x VII
21.Nassar, A. A., Boyle, M. E., Seifert, K. M., Beer, K. A., Apsey, H. A., Schlinkert, R.
T., . . . Cook, C. B. (2012). Insulin pump therapy in patients with diabetes
undergoing surgery. Endocrine Practice, 18(1), 49-55. doi: 10.4158/ep11157.or IV
22.Nassar, A. A., Partlow, B. J., Boyle, M. E., Castro, J. C., Bourgeois, P. B., & Cook,
C. B. (2010). Outpatient-to-inpatient transition of insulin pump therapy: Successes
and continuing challenges. J Diabetes Sci Technol, 4(4), 863-872. IV
23.Noschese, M. L., DiNardo, M. M., Donihi, A. C., Gibson, J. M., Koerbel, G. L., Saul,
M., . . . Korytkowski, M. T. (2009). Patient outcomes after implementation of a
protocol for inpatient insulin pump therapy. Endocrine Practice, 15(5), 415-424. doi:
10.4158/ EP09063.ORR VI
Type Of Evidence Supporting The Recommendations (the type of supporting evidence is
identified and graded for each recommendation)
Describes the type of evidence supporting the recommendations.
Category Number of references (used in recommendations) in each category
I 1
II 0
III 0
IV 5
V 0
VI 1
VII 16
POTENTIAL BENEFITS/HARMS OF IMPLEMENTATION
Potential Benefits
By implementing this guideline, nursing will further improve patient care which should
lead to optimal patient outcomes.
Potential Harms
There are no potential harms associated with implementing this guideline.
IMPLEMENTATION OF THE GUIDELINE

Copyright © 201� University of Wisconsin Hospital s and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
13
Description Of Implementation Strategy
Implementation strategies will vary based on practice improvement needs of individual
units/clinics using this guideline. Clinicians involved with implementation should evaluate
practice related to the guideline recommendations in order to identify gaps and prioritize
improvement plans.
Implementation Tools
Utilization of the Evidence-Based Practice Implementation Model from the University of
Iowa Hospital & Clinics (Cullen, L. & Adams, S., In review) is recommended.
IDENTIFYING INFORMATION AND AVAILABILITY
Date Released (Revised)
2010 (revised 2014)
Guideline Sponsor
UWHC Nursing
Guideline Authors
Diabetes Clinical Nurse Specialist
Guideline Availability
Guideline is available on UWHC intranet (i.e., U-Connect).
DISCLAIMER
Guidelines are designed to assist clinicians by providing a framework for the evaluation and
treatment of patients. This guideline outlines the preferred approach for most patients. It is not
intendHG�WR�UHSODFH�D�FOLQLFLDQ¶V�MXGJPHQW�RU�WR�HVWDEOLVK�D�SURWRFRO�IRU�DOO�SDWLHQWV��,W�LV�
understood that some patients will not fit the clinical condition contemplated by a guideline and
that a guideline will rarely establish the only appropriate approach to a problem.