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Anesthesiology - Insulin Infusion - Adult - Supplemental [4138]

Anesthesiology - Insulin Infusion - Adult - Supplemental [4138] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Anesthesiology


Anesthesiology - Insulin Infusion - Adult - Supplemental [4138]
Intended for Adult Patients Only
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 [149602]
Notify Provider [NURCOM0001] Provider to Notify: Other (Comment)
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 200 mg/dL
If blood glucose < (mg/dL): 90 mg/dL
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other: Hypoglycemia has not resolved within 30 minutes of
either the Wisconsin Insulin Infusion Standard or HIGH Dose
- Adult - Practice Protocol treatment orders,Infusion rate is
less than 1 unit/hour with glucose values less than Target
Range.
PACU
Medications
Insulin Drip [112327]
Wisconsin Insulin Infusion HIGH Dose-Adult-Practice
Protocol (ICU only)
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/delegationpractice-protocols/practice-
protocols/resources/name-18867-en.file
Wisconsin Insulin Infusion Standard Dose- Adult -
Practice Protocol
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/delegationpractice-protocols/practice-
protocols/resources/name-18867-en.file
Note: Discontinue all previous insulin orders and oral
hypoglycemic agents [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)
Insulin Drip Initiation [18803]
Page 1 of 3
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/20/2016 10:33:11 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 05/2016CCKM@uwhealth.org

Wisconsin Insulin Infusion HIGH Dose-Adult-Practice
Protocol (ICU only)
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/delegationpractice-protocols/practice-
protocols/resources/name-18867-en.file
Wisconsin Insulin Infusion Standard Dose-Adult-Practice
Protocol
URL: https://uconnect.wisc.edu/clinical/references/inpatient-
diabetes-management/practice-
resources/resources/name-18867-en.file
Note: Discontinue all previous insulin orders and oral
hypoglycemic agents [950018]
ONCE For 1 Doses
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)
Hypoglycemia Management [203320]
Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/guidelines/diabetes-and-
endocrinology/resources/name-77827-en.file
Hypoglycemia Management (Adult) [191576]
Adult Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/cpg/guidelines/diabetes-and-
endocrinology/resources/name-77827-en.file
Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For Until specified,
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?
Glucose, POC [IPGLUCOSE] AFTER PROVIDING HYPOGLYCEMIA TREATMENT,
Starting today For Until specified, 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?
Per hypoglycemia treatment algorithm Recheck glucose
15 minutes after providing treatment until glucose is
greater than or equal to 70 mg/dL. If patient has been
critically low (i.e., glucose less than 40 mg/dL), recheck
glucose after 1 hour to ensure glucose remains greater
than or equal to 70mg/dL. After resolution of mild
hypoglycemia (i.e., glucose 40-69 mg/dL), consider
rechecking after 1 hour if patient has signs/symptoms of
hypoglycemia or is at risk for a subsequent hypoglycemic
event (e.g., previously administered insulin still active,
altered renal status, altered mental status, NPO or
interrupted nutrition, or any other condition that increases
hypoglycemia risk)
Notify Provider [NURCOM0001] Provider to Notify: Provider
Notify based on: Blood Glucose,Other
If blood glucose > (mg/dL): 400
If blood glucose < (mg/dL): 40
Other: Nutritional status changes
Hypoglycemia Treatment for blood glucose less than 40
mg/dL and patient able to eat/swallow safely
[NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If blood glucose less than
40mg/dL and patient able to eat/swallow safely.
Give 30 grams of carbohydrate (8 oz. of fruit juice). Repeat
treatment until glucose is 70 mg/dL or greater.
Hypoglycemia Treatment for blood glucose between 40
to 69 mg/dL and patient able to eat/swallow safely
[NURCOM0022]
CONDITIONAL, Starting today For Until specified
If Conditional, What Condition? If glucose is 40-69 mg/dL
and patient able to eat/swallow safely
Give 15 grams of carbohydrate (4 oz of fruit juice). Repeat
treatment until glucose is 70 mg/dL or greater.
Page 2 of 3
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/20/2016 10:33:11 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org

glucose-vitamin C chew tab [50690] 16 g, Oral, EVERY 15 MINUTES PRN, hypoglycemia,
Hypoglycemia, For blood glucose 40-69 mg/dL
Use in patients able to safely eat/swallow but unable to
tolerate volume of fruit juice or per patient preference.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater.
glucose-vitamin C chew tab [50690] 32 g, Oral, EVERY 15 MINUTES PRN, hypoglycemia,
Hypoglycemia, For blood glucose less than 40 mg/dL
Use in patients able to safely eat/swallow but unable to
tolerate volume of fruit juice or per patient preference.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater.
glucagon injection kit [107799] 1 mg, Subcutaneous, PRN, For blood glucose less than 69
mg/dL and patient unable to eat/swallow safely AND has
NO IV access
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 12.5 g, Intravenous, PRN, For blood glucose 40-69 mg/dL
and patient unable to eat/swallow safely AND has IV
access
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
dextrose injection [800233] 25 g, Intravenous, PRN, For blood glucose less than 40
mg/dL and patient unable to eat/swallow safely AND has IV
access.
Repeat every 15 minutes until blood glucose is 70 mg/dL
or greater. See Adult Hypoglycemia Algorithm
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting today For 7 Days,
STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose is
less than 40 mg/dL or greater than 400 mg/dL.
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT, Starting 5/28/16 For 7
Days, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose is
less than 40 mg/dL or greater than 400 mg/dL.
Laboratory
Conditional Labs [143641]
GLUCOSE [GLU] CONDITIONAL - RN COLLECT For 7 Days, Routine
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose is less
than 40 mg/dL or greater than 400 mg/dL.
Draw if blood glucose is less than 40 mg/dL or greater than
400 mg/dL.
GLUCOSE, WHOLE BLOOD [HCWBGLU] CONDITIONAL - RN COLLECT For 7 Days, STAT
If add on test, what should lab do if unable to add test to
previous specimen?
If Conditional, What Condition? Draw if blood glucose is
greater than 400 mg/dL.
Draw if blood glucose is greater than 400 mg/dL.
Page 3 of 3
Printed by GUETZLAFF, SCOTT F [SFG091] at 5/20/2016 10:33:11 AM
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2016CCKM@uwhealth.org