Unique Plan Description: OB Insulin INfusion
Plan Selection Display: OB Insulin INfusion
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2011-11-26 15:10:05
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2022-06-01 08:34:30
Available at all facilities: No

OB Insulin INfusion
Laboratory
	Glucose POC - RN
		T;N+60, Q1H
		T;N, As needed for signs and symptoms of hypoglycemia
IV Solutions
		Discontinue any previous insulin and/or oral diabetic medication orders when starting insulin drip(NOTE)*
		***Insulin Infusion needs own IV site, do not infuse with Magnesium Sulfate or Pitocin(NOTE)*
	insulin regular 100 units/NS 100 mL Premix
		100 mL, IV, Routine, T;N, Titrate, Total Volume = 100
			Comment: Concentration: 1 unit/mL, Initial rate based on initial glucose:  101-140: 1 units/hr;  141-180:  1.5 units/hr; 181-220: 2 units/hr;   221-300: 3 units/hr; >301: 4 units/hr; Titrate infusion to target glucose of 101-140:  If glucose is:1) Less than 80 discontinue infusion, continue blood glucose monitoring and follow OB Hypoglycemia Protocol if necessary; restart drip at 1/2 previous rate when glucose >100.  2) 80-100, decrease infusion by 1 unit/hr. 3) 101-140, no change.4) 141-180, and is greater than or equal to the previous glucose, increase infusion by 0.5 unit/hr.5) 141-180, and is less than the previous glucose, maintain same rate.  6) 181-220, increase infusion by 1 unit/hr. 7) >221, increase infusion by 2 unit/hr.  Contact MD if rate >10 unit/hr.If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes. If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physicianNotify MD if glucose >220.  ***Insulin Infusion needs own IV site, do not infuse with Magnesium Sulfate or Pitocin
		100 units, EVERY BAG, 1 units/hr
		100 mL, IV, Routine, T;N+960, Titrate, Total Volume = 100
			Comment: Concentration: 1 unit/mL, Initial rate based on initial glucose:  101-140: 1 units/hr;  141-180:  1.5 units/hr; 181-220: 2 units/hr;   221-300: 3 units/hr; >301: 4 units/hr; Titrate infusion to target glucose of 101-140:  If glucose is:1) Less than 80 discontinue infusion,continue blood glucose monitoring and follow OB Hypoglycemia Protocol if necessary; restart drip at 1/2 previous rate when glucose >100.  2) 80-100, decrease infusion by 1 unit/hr. 3) 101-140, no change.4) 141-180, and is greater than or equal to the previous glucose, increase infusion by 0.5 unit/hr.5) 141-180, and is less than the previous glucose, maintain same rate.  6) 181-220, increase infusion by 1 unit/hr. 7) >221, increase infusion by 2 unit/hr.  Contact MD if rate >10 unit/hr.If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes. If enteral and/or parenteral nutrition support is stopped or held, decrease infusion to 0.5 unit/hour and notify physicianNotify MD if glucose >220.  ***Insulin Infusion needs own IV site, do not infuse with Magnesium Sulfate or Pitocin
		100 units, EVERY BAG
	Dextrose 5% in Lactated Ringers
		1,000 mL, IV, 125 ml/hr
			Comment: use if blood glucose is </= 100
	Sodium Chloride 0.9%
		1,000 mL, IV, 125 ml/hr
			Comment: use if blood glucose is >101
Medications
	insulin regular
		5 units, Solution-Injection, IV Push, Once, PRN, see comment
			Comment: Prior to starting insulin drip if initial blood glucose 301 or greater
Patient Care
	Notify MD
		T;N, for instructions if dietary change: abrupt change in oral intake, change to NPO status, tube feedings are held or discontinued, TPN held or discontinued.  (caloric intake necessary to prevent hypoglycemia)
		T;N, If insulin requirements > 10units/hr for further instruction
	Notify MD of Lab results
		T;N, if blood glucose is not less than 180 after 6 hours on the OB Insulin Infusion protocol.
	IV Insulin Parameters
		T;N, Decrease infusion to 0.5 units/hour if enteral and/or parenteral nutrition support is stopped or held and notify physician.
		T;N, If the glucose decreases >75mg/dl from the last glucose check, decrease insulin rate by 50% and check blood glucose in 30 minutes.
		T;N, If initial glucose < 101, do not start infusion.  Enter order for blood glucose Q4H and start infusion if necessary based on parameters.
	Order Lab
		When glucose is in target range (101-140) for 6 hours, cancel glucose Q1H order and enter new glucose order Q2H.  If glucose falls out of target range, change glucose checks back to Q1H until in range again for 6 hours

OB Hypoglycemia Protocol
Laboratory
		T;N, Blood Glucose (POC) as needed for signs and symptoms of hypoglycemia
Medications
	Dextrose 50%
		25 mL, Injection, IV Push, Q15MIN, PRN for low blood sugar, Routine
			Comment: Give if blood glucose less than 55mg/dL or 56-79 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	Dextrose 10% in Water (FH)
		250 mL, Injection, IVPB, Q30MIN, PRN for low blood sugar, infuse over 30 min(s)
			Comment: Give if blood glucose less than 55mg/dL or 56-79 mg/dL and patient unable to tolerate oral intake. Notify provider if given with corresponding POC glucose recheck value.
	glucagon
		1 mg, Injection, IV Push, Q15MIN, PRN for low blood sugar, Routine
			Comment: Give if blood glucose < 55mg/dL, if dextrose 50% injectable unavailable and blood glucose 56-79 mg/dL, or inadequate response to IV dextrose 50%. May give SubQ or IM if patient does not have IV access. Notify provider if given with corresponding POC glucose recheck value.
Patient Care
	IV-Maintain
		T;N
			Comment: Patient must have IV site while on hypoglycemia protocol.
	Hypoglycemia Treatment Parameters
		T;N, Hypoglycemia protocol initiated for patients with glucose <80mg/dl.
			Comment: Patient must have IV site while on hypoglycemia protocol.
		T;N, blood glucose <40mg/dl (critical value),
			Comment: Discontinue any insulin infusion and treat with Dextrose 50%, 25 ml. Notify physician immediately and repeat glucose 15 minutes after treatment
		T;N, glucose 40-55 mg/dL give Dextrose 50% 25 mL.
			Comment: Discontinue any insulin infusion and treat with Dextrose 50%, 25 ml. Notify physician immediately and repeat glucose 15 minutes after treatment
		T;N, glucose 56-79 mg/dL,
			Comment:  if Patient asymptomatic, recheck blood glucose in 30 minutes.  If symptomatic, administer 4 oz apple juice.  If patient NPO or unable to tolerate oral intake, give Dextrose 50%, 25ml.  Repeat glucose in 15 minutes after treatment
		T;N
			Comment: Give 1 complex carb and 1 protein snack or patient meal if patient able to take orals any time hypoglycemia is treated.
		T;N
			Comment: When blood glucose is greater than 100 mg/dL; if indicated, restart Insulin infusion at ½ previous rate and change glucose checks to every hour until glucose is in the target range (101 - 140) for 6 hours, then may change to Q2H glucose checks.

*Report Legend:
DEF - This order sentence is the default for the selected order
GOAL - This component is a goal
IND - This component is an indicator
INT - This component is an intervention
IVS - This component is an IV Set
NOTE - This component is a note
Rx - This component is a prescription
SUB - This component is a sub phase