/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/order-sets/,/clinical/cckm-tools/content/order-sets/inpatient/,/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/,

/clinical/cckm-tools/content/order-sets/inpatient/hospital-wide/name-98275-en.cckm

201705146

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Hospital-wide

IP – Diabetic Ketoacidosis – Adult – Supplemental [1335]

IP – Diabetic Ketoacidosis – Adult – Supplemental [1335] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Hospital-wide


IP - Diabetic Ketoacidosis - Adult - Supplemental [1335]
for Adult Patients OnlyIntended
Algorithm for Adult Patients in DKA URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97512-en.cckm
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 [17726]
Notify [NURCOM0001] CONTINUOUS
Provider to Notify: Provider
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):
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL): 30 mL/hour
Other: Potassium less than *** or greater than ***
milimole/liter,Hypoglycemia not resolved within 30
minutes of Insulin Infusion Algorithm hypoglycemia
treatment orders,Insulin infusion rate is less than 1
unit/hour with glucose values less than Targeted
Range,ICUs only: When patient initially meets criteria
to move to columns 7-9, If patient transferring from
ICU to general/IMC care and still requiring high dose
columns 7-9
Intravenous Therapy
Intravenous Therapy [202832]
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Note: Notify Provider when glucose declines to
200 mg/dL or lower to order IV Fluid containing
5% Dextrose [950018]
ONCE PRN For 1 Doses, When glucose declines to
200 mg/dL or lower
Note:Notify Provider when glucose declines to 200
mg/dL or lower to order IV Fluid containing 5%
Dextrose
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
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)
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
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)
Nutritional Insulin (Single Response) [145568]
Insulin Lispro with Insulin to Carbohydrate Ratio
(Carb Counting) [129171]
Page 2 of 10
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:15:14 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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05/2017CCKM@uwhealth.org

Select Insulin to Carbohydrate Ratio (ICR)
STEP 1: Calculate the patient’s Total Daily Dose
STEP 2: Select corresponding ICR. (Enter Admin Instructions below)
STEP 3: Adjust ICR if glucoses remain >180 mg/dL.
Other Considerations:
• A custom ICR may be entered for pts with established regimen at home.
• RENAL INSUFFICIENCY/FAILURE: select a higher ratio to decrease hypoglycemia risk (e.g.,
if patient’s TDD is 40 units increase the ICR from 1:12 to 1:15
• BASAL INSULIN ONLY PTA (dose >/=40 units/day): select corresponding ICR using chart
above; then reduce basal dose by 25-50%.
Insulin to Carbohydrate Ratios- Adult (ICRs) URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97513-en.cckm
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection [53264]
0-30, Subcutaneous, 3 X DAILY (AT MEALTIME)
Insulin to Carbohydrate Ratio (ICR) {RXR INSULIN
TO CARBOHYDRATE RATIO (ICR):2000496}
Document carbohydrate grams eaten in Doc
Flowsheet.
Measure Carbohydrate Intake [NURDIE0016] CONTINUOUS, Routine, Document carbohydrate
grams eaten in Doc Flowsheet
insulin lispro - Note: Snack carbohydrate
counting dose [53264]
0-30, Subcutaneous, PRN, For snacks > 30 g
Insulin to Carbohydrate Ratio (ICR) {RXR INSULIN
TO CARBOHYDRATE RATIO (ICR):2000496}
Document carbohydrate grams eaten in Doc
Flowsheet
insulin lispro (human) (HUMALOG) 100 UNIT/ML
injection [53264]
4 units, Subcutaneous, 3 X DAILY (AT MEALTIME)
Hold dose if patient NPO. Give half dose if patient
eating <50% of meal. Give within 15 minutes of meal
Potassium Chloride Supplements (Single Response) [18810]
potassium chloride 10 mEq/100 mL bag [46253] 10 mEq, Intravenous, ONCE PRN For 1 Doses, Urine
output is equal to or greater than 50 mL/hr and
potassium level is less than or equal to 5 mmol/L
Use when patient urine output is equal to or greater
than 50 mL/hr and potassium level is less than or
equal to 5 mmol/L.
Administer over 60 minutes.
for 60 Minutes
Total Daily Dose (TDD)
(total amount of scheduled basal
and nutritional insulin doses in 24
hours)
Insulin to Carbohydrate Ratio
(ICR) (1 unit insulin covers ____
grams of carbohydrate)
15 - 29 units 1 unit:20 grams
30 – 39 units 1 unit:15 grams
40 – 49 units 1 unit:12 grams
50 – 59 units 1 unit:10 grams
60 - 89 units 1 unit:8 grams
90-119 units 1 unit:5 grams
> 120 units 1 unit: 4 grams
Page 3 of 10
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:15:14 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
05/2017CCKM@uwhealth.org

potassium chloride 20 mEq/ 100 mL bag [46255] 20 mEq, Intravenous, ONCE PRN For 1 Doses, Urine
output is equal to or greater than 50 mL/hr and
potassium level is less than or equal to 5 mmol/L
Administer via central line over 60 minutes.
Use when patient urine output is equal to or greater
than 50 mL/hr and potassium level is less than or
equal to 5 mmol/L.
for 60 Minutes
Medications - Hypoglycemia Treatment
Hypoglycemia Management [123771]
URL:
Hypoglycemia Management (Adult) [191576]
Adult Hypoglycemia Treatment Algorithm URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/diabetes-and-
endocrinology/related/name-97511-en.cckm
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] CONTINUOUS
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.
Page 4 of 10
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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05/2017CCKM@uwhealth.org

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.
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 6/3/17 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
Obtain if Not Done Within Last 90 Days [19217]
Page 5 of 10
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05/2017CCKM@uwhealth.org

HEMOGLOBIN A1C [HA1C] NEXT DRAW, 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?
Every 8 Hours [19942]
BETA-HYDROXYBUTYRATE [XBOH] EVERY 8 HOURS, Starting today For 24 Hours,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every 2 Hours Times 4, Then Every 4 Hours [17847]
ELECTROLYTES [LYTE] EVERY 2 HOURS, Starting today at 4:06 PM For 2
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every 2 Hours Times 2, Then Every 4 Hours.
ELECTROLYTES [LYTE] EVERY 4 HOURS, Starting today at 10:04 PM For 2
Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every 2 Hours Times 2, Then Every 4 Hours.
PHOSPHATE [PHOS] EVERY 2 HOURS, Starting today at 4:05 PM For 2
Occurrences, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every 2 Hours Times 2, Then Every 4 Hours.
PHOSPHATE [PHOS] EVERY 4 HOURS, Starting today at 10:05 PM For 2
Days, Routine
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
Every 2 Hours Times 2, Then Every 4 Hours.
On Admission - If Not Done in ED [17727]
BLOOD GASES AND O2 SATURATION
[HCBGASOS]
NEXT DRAW, Starting today For 1 Occurrences,
Routine
Indicate FIO2:
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
PHOSPHATE [PHOS] NEXT DRAW, 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?
ELECTROLYTES [LYTE] NEXT DRAW, 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?
Page 6 of 10
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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05/2017CCKM@uwhealth.org

BUN [BUN] NEXT DRAW, 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?
CREATININE [CRET] NEXT DRAW, 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?
GLUCOSE [GLU] NEXT DRAW, 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?
CALCIUM [CA] NEXT DRAW, 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?
BILIRUBIN, TOTAL [TBIL] NEXT DRAW, 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?
PROTEIN, TOTAL [TP] NEXT DRAW, 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?
ALBUMIN [ALB] NEXT DRAW, 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?
ALKALINE PHOSPHATASE [ALKP] NEXT DRAW, 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?
AST/SGOT [AST] NEXT DRAW, 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?
ALT/SGPT [ALT] NEXT DRAW, 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?
CBC WITH DIFFERENTIAL [CBC] NEXT DRAW, 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?
CULTURE, BLOOD, BACTERIA/YEAST (2
SITES) [116728]
Page 7 of 10
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.Practices for Blood Culturing Best This order equals 2 sites (4 bottles). See link below for
Best Practices for Blood Culturing URL: https://uconnect.wisc.edu/clinical/references/laboratory-
services/blood/
Lab Test Directory URL: https://uconnect.wisc.edu/clinical/tools-
resources/lab-test-directory/microbiology/name-
67798-en.labtest
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
ONCE, Starting today For 1 Occurrences, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures
on subsequent days are of minimal diagnostic
value. Culture detects bacteria, Candida and
Cryptococcus. If filamentous fungi are suspected
see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
CULTURE, BLOOD, BACTERIA AND YEAST
[GM4045]
ONCE, Starting today For 1 Occurrences, Routine,
For optimum diagnosis of sepsis, sample 3-4 sites
only on the first day of a septic episode. Cultures
on subsequent days are of minimal diagnostic
value. Culture detects bacteria, Candida and
Cryptococcus. If filamentous fungi are suspected
see Culture, Blood, Filamentous Fungi.
Patient's Active Lines:
No Active Lines Found.
If Conditional, What Condition?
CULTURE, SPUTUM WITH GRAM STAIN
[HCSPUCS]
ONCE, Starting today For 1 Occurrences, Routine,
For patients with an ET tube or tracheostomy,
quantitative mini-BAL by RT or bronchoscopic BAL
are the preferred methods of specimen collection.
If add on test, what should lab do if unable to add test
to previous specimen?
If Conditional, What Condition?
BETA-HYDROXYBUTYRATE [XBOH] NEXT DRAW, 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?
URINALYSIS WITH MICROSCOPY [UA] ONCE, 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
Diabetes Consult Order Panel (Adult) [188497]
Page 8 of 10
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Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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05/2017CCKM@uwhealth.org

Diabetes Management Service : Will provide management or treatment recommendations for
patients with hyperglycemia and/or those who report outpatient use of insulin or other diabetes
medications. Patients should be expected to remain inpatient > 24 hrs from time of consult.
Consult is required for patients with insulin pumps or who use U-500 insulin. Consult Endocrine
for any non-diabetes-related endocrine questions.
Learning Center - Diabetes Education (Adult): Diabetes Education (Adult): Diabetes
education (meter/insulin skills/other diabetes survival skills) for patients/families with knowledge
deficits and/or need for diabetes knowledge assessment. Recommended for all new
diagnoses or patients with A1C > 9.
Diabetes Education – Nutrition: Diabetes nutrition therapy including nutrition assessment,
carbohydrate education (consistent carbohydrate meals, use of insulin-to-carbohydrate ratio),
and/or individualized, nutritious meal planning for carbohydrates, portions, or considering other
comorbidities. Recommended for all new diagnoses or patients with A1C > 9
Consult Diabetes Management Service (DMS)
(Inpatient) [CON0022]
ONCE
Can this consult be done via video?
Call back number:
Intent: Consult and Recommend (Write Orders)
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis):
Consult Learning Center - Diabetes Education
(Adult) [CON0021]
ONCE, Routine, - If patient is newly diagnosed or is
new to insulin, provide 24 hours notice to allow
adequate time for education,
- Indicate diabetes medication/treatment plan if
known.
- Consults requested after 1600 on Fridays may not
be seen until following Monday. Learning Center
available Mon-Sat 0800-1630 (only 1 RN available on
Saturday for CSC and AFCH).
- Staff may be contacted by Pager 7927 on weekdays
and Pager 3276 on weekends.
- Learning Center staff are not available on holidays.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
Page 9 of 10
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:15:14 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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Consult Diabetes Education - Nutrition (Inpatient)
[CON0126]
ONCE, Routine, · If your patient is newly diagnosed
and/or is new to insulin therapy, provide 24 hours
notice to allow adequate time for nutrition education.
· Indicate diabetes medication/treatment plan if
known.
· Consults requested after 1300 on Friday may not
be completed until the following Monday.
· If you are placing a consult on a weekend day for a
patient who will be discharging that weekend, please
have the Paging Center contact the on-call dietitian to
help you facilitate the diabetes nutrition education
session prior to the patient's discharge.
Type of Education: Diabetes Self-Management
Education
Reason For Consult:
Expected Discharge Date:
Diabetes management / treatment plan:
Can this consult be done via video?
BestPractice
No Hospital Problems have yet been identified. [107035]
Specify Hospital Problem(s) [COR0018] You will be prompted to specify a hospital problem on
signing.
Page 10 of 10
Printed by SPENCER, LINDSEY M [LMS033] at 5/26/2017 11:15:14 AM
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
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05/2017CCKM@uwhealth.org