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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



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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 o f patients using their own insulin pumps
(continuous subcutaneous insulin infusions) while hospitalized. Specifically, this guideline addresses:
• O rga n iz ational need s
• Assessment
• Documentation
• Management
• 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 o ther managing the pump for the patient) to manage his/her pump when acutely
ill.

7,11,14-17


5. The patient’s competence for us ing a pump during acute 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 Hospitals and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
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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 ca theter 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 con tinue in sulin
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), clinica l 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
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
• UW Health C linical Policy 2.3.19: Subcutaneous Insulin Pump (Patient’s Own) and Continuous
Glucose Monitor Use in the Hospital Setting
B. Patient Education Resources
• Hea lth Facts for You #7012: Using Your Insulin Pump in the Hospital
• Hea lth Facts for You #6979: Problem Solving High Blood Sugars When Using an Insulin Pump

Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Last Revised: 01/2017EArsenaultknudsen@uwhealth.org
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• Hea lth Facts for You #7948: Insulin Pump Requirements
• Hea lth 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 tria l, consistent negative
evidence from well-designed controlled trials using small samples, or guidelines
deve loped from evidence and supported by expert opinion.
Not
recommended
for Practice:
Interventions for which lack of e ffectiveness 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.