Insulin Education PowerPoint - Valley Hospital

atThe Valley Hospital (TVH)forNursing Students/Nursing Instructors2012

Subject - Insulin SafetyBackgroundInsulin known to be high risk medicationCan promote serious hypoglycemia if givenincorrectlyAssessment5 “RIGHTS” of administration MUST be followedRecommendationAll student nurses will observe this presentationand successfully complete the post-test

All nursing students administering insulinwill have their clinical instructorORthe patient’s primary nurse double checkdose, time and type of insulin to be given

HUMALOG (Insulin lispro) Rapid Acting- Inject within 15 minutes before meals orimmediately after mealsHumulin R (Regular Insulin) Short Acting- Inject within 30 – 60 minutes before mealsHumulin N (NPH Insulin) Intermediate- Administer as per health care provider order

Levemir (Insulin detimir) Long Acting- Administer once or twice dailyLantus (Insulin glargine) Long Acting- Administer once or twice daily – if given onceper day, usually given at bedtimeNovolin Mix 70/3070% NPH and 30% RegularNovolog Mix 70/3070% NPH and 30% Novolog

EACH patient will receive his OWN vial of insulinfrom pharmacy-write date on label when first opened-keep vial in marked insulin bin in medicationroom when not being used-discard in sharps container upon pt. discharge-do NOT share vials-may return to pharmacy if unopened upondischarge

• Insulin syringes are always 100 unit per ml• Can come in three sizes – 30 unit50 unit100 unitAll insulin doses to be administered viasubcutaneous route at 90 degree angleUnder unique circumstance, regular insulin can begiven IV

• While insulin pens are popular for home use –easy to use and carryThey are NOT to be used at TVH for adults. Ifpatient brings their own pen and insists on using,it must be sent to pharmacy for identification andonly patient self medicatesONLY pediatric inpatients may use insulin penswith supervision for education purposes

Any patient admitted with hypo/hyperglycemiaDKA diagnosisNew Diabetes diagnosis – Primary or SecondaryNeed for glucometer and instructionNew to insulinPt/Family requestNurse assessment identifies education needAsk primary RN to submit diabetes educationconsult if not already done.

PleaseAsk primary RN to submit dietary consult request

• Pre-meal Accu-Chek glucose readings shouldbe taken NO More than 30 minutes prior tomeal and insulin administration• Download glucometer immediately afterglucose obtained• NOTE: if meter is NOT returned to base fordownload within 1 hour, meter will not allowoperator to use. Meter MUST be returned tobase

• Critical Results identified by glucometer• Above 400• Under 50These results are reportable and require a venousblood draw to confirm. Treat any glucose reading of70 mg/dl as hypoglycemia weather patient issymptomatic or not

• For critically ill patient in ICU-maintain glucose level between 140 mg/dland 180 mg/dl-lower glucose targets may be appropriatein selected patients BUT targets below110 mg/dl not recommended- use continuous insulin infusion tomaintain this control

• For NON critically ill medical surgical patients• Pre-meal glucose target should generally beless than 140 mg/dl• Random level less than 180 mg/dl

• As per the ADAAny glucose less than 70mg/dl, with or withoutsymptoms MUST be treated with 15 gramscarbohydrate (ex: 4 ounces fruit juice –apple juice if renal patient)Recheck accu-chek again in 15 minutes. Ifglucose remains low, retreat and checkagain in 15 minutes ETC……….RULE OF 15’SIF PATIENT UNRESPONSIVE, contact RapidResponse Team at in-house beeper #50-0776

• If patient is admitted with own Insulin Pump• Refer to Patient Care Services (PCS) Policy#44.61• Submit Diabetes Education Consultation• Patient MUST be able to maintain COMPLETEcontrol-provide all supplies-change insertion site every 3 days-complete and sign agreement form anddaily flow sheet

If there are any concerns over apatient’s ability to manage theirinsulin pump, contact a DiabetesEducator: In-house beeper #50-0664If educator not available, call healthcare provider about removing insulinpump and obtain subcutaneousinsulin orders

•Thank you for yourattention.•Please complete the posttest.Passing score is 100%.