Adult SQ Insulin Advisor • Be on the look-out for VUMC’s new subcutaneous adult insulin advisor • Orderable in WIZ/HEO. • Physician Driven, unlike the Insulin Infusion Protocol, which is nurse driven. Currently being piloted on cardiology service. Implementation for Medicine service schedule for Nov. 3rd.
What’s Different? • While it is NOT the nurse’s responsibility to order or manage the adult sq insulin advisor, there will be a few noticeable changes in both WIZ/HEO and HED/Admin-Rx. • All patients will have blood glucose checks on an ACHS schedule. • Option to automatically order basal and mealtime insulin doses. • Sliding scale correction numbers different. (New Hypoglycemic scale is ≤70 instead of ≤60) • Option of using oral glucose gel for hypoglycemia instead of IV D50
ORDERING THE ADVISOR; DONE BY PROVIDER Adult insulin advisor is an orderable item in WIZ/HEO that is done by the provider. If a weight has not been entered into WIZ/HEO, the provider will receive a pop-up requiring them to enter one before proceeding.
PROVIDER ORDER SCREEN Insulin requirement based on diabetes type, weight, and insulin requirement at home. The advisor makes recommendations for basal and meal insulin amounts. After completing steps 1, 2, and 3, the advisor makes recommendations for basal and meal insulin amounts. Sliding scale automatically entered based on dosing level of insulin. **NEW CORRECTIVE SCALE IS ≤70 INSTEAD OF ≤60!
WIZ Orders Before Advisor Only bedside testing, sliding scale, and IV D50 ordered automatically before using the advisor.
WIZ Orders After Advisor • Notice the differences: • Patients automatically identified as diabetic. • Mealtime and basal dose can be automatically ordered. • Schedule now ACHS. • BG low range now ≤70. • Option of giving either IV D50 or oral glucose gel.
HED Before the Advisor Only sliding scale dose and D50 are ordered. If provider wants to add a mealtime or basal dose, this must be done separately
HED After the Advisor Notice patient now has basal, mealtime, and sliding scale dose all ordered at once. Also, D50 and oral glucose gel automatically ordered.