Unique Plan Description: CT Surg Cardiac Surgery, ERA (MH) Insulin Aspart
Plan Selection Display: CT Surg Cardiac Surgery, ERA (MH) Regular Insulin
PlanType: Medical                                 
Version: 3          
Begin Effective Date: 2021-05-24 08:43:26
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2024-05-07 10:41:06
Available at all facilities: No

CT Surg Cardiac Surgery, ERA (MH) Insulin Aspart
IV Solutions
	insulin regular 100 units/NS 100 mL Premix
		100 mL, IV, Routine, T;N, Total Volume = 100
			Comment: Concentration:1 unit/mL, Rate:  2 mL/hr = 2 units/hr, continuous if initial glucose greater than 150.Titration of regular insulin IV infusion:If glucose is: 1.)  Less than 70 discontinue infusion and follow hypoglycemia treatment parameters.2.)  if glucose < 100 stop infusion for 1 hour, then resume at half previous dose.3.)  100-150, no change4.)  Greater than 150, and is greater than or equal to the previous glucose, increase infusion by 1 unit/hour.5.)  Greater than 150, and is less than the previous glucose, maintain the same rate.6.)  Greater than 200, increase infusion by 2 units/hour. Initiate insulin drip 4 hours prior to surgery or as otherwise directed. Obtain glucose POC-RN q1hr starting with initiation of drip. Discontinue Regular Insulin Infusion 48 hours after surgery
		100 units, EVERY BAG, 2 units/hr
Medications
	Dextrose 50%
		25 mL, Injection, IV Push, Q15MIN, PRN for low blood sugar
			Comment: Give if blood glucose less than 60mg/dL or 60-70 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, T;N
			Comment: Give if blood glucose < 70mg/dL AND if dextrose 50% injectable unavailable 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.
	Moderate Dose NovoLOG
		4 - 24 units, Injection, SUBCUTANEOUS, Q6H-Sch, PRN, sliding scale
			Comment: Begin 48 hours after surgery<< Sliding Scale Comments >>Under 150, Do not give any insulin150 - 199 = 4 units,200 - 249 = 8 units,250 - 299 = 12 units,300 - 349 = 16 units,350 - 399 = 20 units.Over 399 = 24 units,<< Sliding Scale Comments >> Check  POC in 3 hours; notify physician if repeat POC  greater than or equal to 400mg or less than or equal to 100.  Do not give insulin based on repeat POC value.  RN may change sliding scale insulin order to before meals and at bedtime for patients on oral diet. Enter as QIDACHS PRN
Patient Care
	Glucose POC - RN
		Q1H
			Comment: After 24 hours, when glucose is in target range (100-150) for 4 hours, cancel q1h glucose order and enter order for q2h.
		T+1;0400, Q1H
			Comment: Start at 0400 or 4 hours prior to start of surgery. After 24 hours, when glucose is in target range (100-150) for 4 hours, cancel q1h glucose order and enter order for q2h.
		T;N+2880, QIDACHS
			Comment: Start 48 hrs after surgery
	Notify MD
		T;N, if glucose POC >200mg/dL for 2 consecutive checks
	Discontinue
		T;N, insulin drip protocol after 48hrs and begin Insulin Sliding Scale Novolog
	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
	Hypoglycemia Treatment Parameters
		T;N
			Comment: Hypoglycemia protocol initiated for patients with glucose <70mg/dl. Blood glucose <40mg/dl (critical value), treat with Dextrose 50%, 25 mL, then immediately notify physician.  Repeat glucose in 15 minutes. Blood glucose 40-55 mg/dL give Dextrose 50% 25 mL. Repeat glucose 15 min after treatment. Notify physician after follow-up value is obtained. Blood glucose 56-70 mg/dL 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.  If repeat glucose 55-70, repeat apple juice or Dextrose. Obtain another glucose, Give 1 complex carb (15g) and 1 protein snack (7g) or patient meal if patient able to take orals any time hypoglycemia is treated.  When blood glucose >150mg/dl, restart infusion at ½ previous rate and change glucose checks to every hour until glucose is within target range (100-150) for 4 hours, then change to Q2H glucose checks.
		T;N, Hypoglycemia protocol initiated for patients with glucose <70mg/dl. Patient should have an IV while on Hypoglycemia protocol.
		T;N, glucose < 60mg/dL  treat with Dextrose 50% 25 mL.OR glucagon 1mg as per medication orders. Notify provider as per critical result protocol. Repeat treatment as outlined in hypoglycemia parameters.
			Comment: Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, glucose 60-70 mg/dL, administer 4 oz apple juice, 4 oz non-diet soda, or glucose gel.  If patient NPO or unable to tolerate oral intake, give Dextrose 50% 25ml , OR glucagon 1mg as per medication orders.
			Comment: Repeat treatment as outlined in hypoglycemia parameters. Notify provider of all treatments given and POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, After initial treatment of any glucose value </= 70 mg/dL, repeat POC glucose in 15 min; if result </= 70mg/dL continue treating as per protocol and rechecking glucose 15 min after treatment until glucose >70mg/dL.
			Comment: Notify provider of all treatments given and corresponding POC glucose recheck values. When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.
		T;N, Once glucose is within normal limits, give 1 complex carb and 1 protein source (such as ½ sandwich OR 1 individual container of peanut butter and 3 packs of crackers) or patient meal if patient able to take orals to prevent recurrent hypoglycemia.
			Comment: When notifying provider of hypoglycemic treatment, clarify with provider future instructions on diabetic medication therapy.

*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