Unique Plan Description: OB Insulin Subcutaneous Pump
Plan Selection Display: OB Insulin Subcutaneous Pump
PlanType: Medical                                 
Version: 1          
Begin Effective Date: 2021-04-20 08:24:00
End Effective Date: 2100-12-31 00:00:00
Last Updated Date: 2021-12-21 10:22:56
Available at all facilities: No

OB Insulin Subcutaneous Pump
Laboratory
	Glucose POC - RN
		T;N, Q1H, see comment
	Hemoglobin A1C
		T+1;0400, Routine, spec type = Blood
Medications
	insulin aspart SUBQ Pump
		3 mL, SUBCUTANEOUS INFUSION, Routine, Titrate
			Comment: Pharmacist to enter:Initial insulin titration schedule from patient's own insulin pump:Carb ratios:Please see physician daily progress notes for modifications or adjustments to patient's dosing schedule throughout inpatient stay.
		1 EA, EVERY BAG
	insulin aspart
		300 units, SEE NOTES, Q24H, PRN, see comment
			Comment: To refill pump
	insulin lispro SUBQ Pump
		3 mL, SUBCUTANEOUS INFUSION, Routine, Titrate
			Comment: Pharmacist to enter:Initial insulin titration schedule from patient's own insulin pump:Carb ratios:Please see physician daily progress notes for modifications or adjustments to patient's dosing schedule throughout inpatient stay.
		1 EA, EVERY BAG
	insulin glulisine SUBQ Pump
		3 mL, SUBCUTANEOUS INFUSION, Routine, Titrate
			Comment: Pharmacist to enter:Initial insulin titration schedule from patient's own insulin pump:Carb ratios:Please see physician daily progress notes for modifications or adjustments to patient's dosing schedule throughout inpatient stay.
		1 EA, EVERY BAG
	insulin regular SUBQ Pump
		3 mL, SUBCUTANEOUS INFUSION, Routine, Titrate
			Comment: Pharmacist to enter:Initial insulin titration schedule from patient's own insulin pump:Carb ratios:Please see physician daily progress notes for modifications or adjustments to patient's dosing schedule throughout inpatient stay.
		1 EA, EVERY BAG
	insulin regular
		300 units, SEE NOTES, Q24H, PRN for see comment
			Comment: To refill pump
Patient Care
	Order Lab
		T;N, RN may change schedule of point of care glucose order to every 6 hours if patient is NPO or not on oral diet (tube/enteral feedings, TPN, etc). Enter POC order as Q6H-SCH, TIMED
	Glucose Level, patient to do own
		T;N, TIDPC
			Comment: Patient may take own blood glucoses or use own CGM in hospital.
		T;N, ACBKFST
			Comment: Patient may take own blood glucoses or use own CGM in hospital.
		T;N, Q12H
			Comment: Patient may take own blood glucoses twice daily in order to calibrate CGM

OB Hypoglycemia Protocol
Laboratory
	Order Lab
		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: should have IV in place for 24hr after delivery and/or patient requiring hypoglycemia treatment
	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