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/clinical/cckm-tools/content/order-sets/ambulatory/general-surgery/name-105416-en.cckm

20180105

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IP/OP - Perioperative Normoglycemia for Surgical Patients Delegation Protocol - Adult [6133]

IP/OP - Perioperative Normoglycemia for Surgical Patients Delegation Protocol - Adult [6133] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Ambulatory, General Surgery


IP/OP - Perioperative Normoglycemia for Surgical Patients Delegation Protocol -
Adult - Supplemental [6133]
for Adult Patients OnlyIntended
Patient Care Orders
Non-Categorized Patient Care Orders [143638]
Glucose, POC [IPGLUCOSE] SEE COMMENTS, Starting today For 7 Days,
Routine, Glucose, POC should always be ordered in
conjunction with orders for hypoglycemia management
and monitoring as indicated in the Hypoglycemia
Management (Adult) panel.
If Conditional, What Condition?
Every hour until within target range of 110-150 mg/dL
for 3 hours (3 readings in a row), then decrease
frequency to every 2 hours. Hourly monitoring must be
resumed if blood glucose deviates from target range.
After Priming IV Tubing with Insulin, Waste 20 mL
Insulin Drip to Saturate all IV Tubing Binding Sites
[NURVAD0053]
CONTINUOUS, Starting today
Contingency Parameters [112155]
Notify Provider - Insulin Infusion [NURCOM0001] Location: UW
Provider to Notify: Provider
Notify based on: Other
Other: Hypoglycemia has not resolved within 30
minutes of Insulin Infusion Algorithm hypoglycemia
treatment orders,Infusion rate is less than 1 unit/hour
with glucose values less than Target Range,ICUs
only: When patient initially meets critieria to move to
columns 7-9,If patient transferring from ICU to
general/IMC care and still requiring high dose columns
7-9
Notify Provider - Diabetes Management Service
[NURCOM0001]
Location: UW
Provider to Notify: Provider
Notify based on: Other
Other: Notify Diabetes Management Service via text
page (#0218) with "FYI - insulin drip started per
protocol, please evaluate." Include medical record
number and inpatient unit location.
Medications
Insulin Drip [18803]
Wisconsin Insulin Infusion HIGH Dose-Adult-
Practice Protocol (ICU only)
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/delegationpractice-
protocols/practice-protocols/related/name-97441-
en.cckm
Wisconsin Insulin Infusion Standard Dose-Adult-
Practice Protocol
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/delegationpractice-
protocols/practice-protocols/related/name-97442-
en.cckm
Discontinue all previous insulin orders and oral
hypoglycemic agents. Perioperative
Normoglycemia Delegation Protocol for Surgical
Patients. DMS consulted as part of the protocol,
page 0218 with questions. [950018]
ONCE For 1 Doses
Page 1 of 2
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 1:58:18 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

insulin regular (human) infusion [700217] 0.2-30 Units/hr, Intravenous, CONTINUOUS
Administer insulin drip in accordance with Insulin
Infusion Algorithm - Adult. (General care and IMC
units - use standard algorithm columns 1-6; ICU only -
use standard and HIGH DOSE columns 1-9)
Insulin Drip [112327]
Wisconsin Insulin Infusion HIGH Dose-Adult-
Practice Protocol (ICU only)
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/delegationpractice-
protocols/practice-protocols/related/name-97441-
en.cckm
Wisconsin Insulin Infusion Standard Dose- Adult -
Practice Protocol
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/delegationpractice-
protocols/practice-protocols/related/name-97442-
en.cckm
Discontinue all previous insulin orders and oral
hypoglycemic agents. Perioperative
Normoglycemia Delegation Protocol for Surgical
Patients. DMS consulted as part of the protocol,
page 0218 with questions. [950018]
ONCE For 1 Doses
insulin regular (human) infusion [700217] 0.2-54 Units/hr, Intravenous, CONTINUOUS
Administer insulin drip in accordance with Insulin
Infusion Algorithm - Adult. (General care and IMC
units - use standard algorithm columns 1-6; ICU only -
use standard and HIGH DOSE columns 1-9)
Laboratory
Obtain If Not Done Within Last 90 Days [143671]
HEMOGLOBIN A1C [HA1C] NEXT AM, Starting today For 1 Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Consults
Consults [212516]
Consult Diabetes Management Service (DMS)
(Inpatient) [CON0022]
ONCE
Can this consult be done via video? No
Call back number:
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be Addressed
(Symptom, Sign, or Diagnosis): Evaluate and Treat
Page 2 of 2
Printed by STRAKA, KEVIN F [KFS1] at 1/4/2018 1:58:18 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org