Insulin Dosing Made Easier

Tuesday, April 22, 2008 at 9:01:06 AM

The Medical Decisions Network-CGS Calculator (an updated version of the Glucomander) is an intravenous insulin dosing software program being introduced at Wilson in the OR, ICU, and CCU the week of April 21. After completion of this roll-out, implementation will take place within 3 months for the rest of Wilson, and then to all of BGH by the end of 2008.

To initiate an IV insulin infusion, a standard order will be signed by the prescriber. The nurse will enter the patient’s name and weight into the computer, and the suggested starting dose will be recommended. An alarm will notify the nurse hourly to perform a fingerstick glucose and enter the results into the computer. The insulin adjustment needed to achieve the target range will be displayed.

In addition, up-dated standard “Basal-Bolus” intensive subcutaneous insulin orders will be utilized for all insulin ordering for (1) time effectiveness of prescribers, (2) continuity for pharmacy and nursing, and (3) to incorporate current scientific based ordering regimes to improve the in-patient glycemic control based on national standards. These standard forms will be available on-line and on the clinical units for the prescribers’ convenience.

Hyperglycemia impacts in-patient mortality! The “regular insulin sliding scale” developed by Dr. Joslin in the 1930's is not effective in treating in-patient hyperglycemia-the RABBIT 2 Trial has made these conclusions. THINK: Basal, Bolus, and Supplemental for effective s.c. insulin dosing!

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