Order Medications—Insulin Dosing Algorithm

• If you haven't already, start the medication order for insulin.

• Select Insulin Algorithm from the Dose drop-down list.

• Complete the algorithm, and generate a chart of doses based on carbohydrate intake and blood glucose:

1. Type values for the patient's carbohydrate ratio (grams of carbohydrate per one unit), target blood sugar (mg/dl), and sensitivity or correction factor per one unit (mg/dl).

2. The dose is rounded down to the nearest whole unit by default. To round down to a half (0.5) unit or a tenth (0.1) unit, select from the Round Down to the Nearest drop-down list.

3. By default,for inpatient orders, the instruction to call the responding clinician is selected, and the blood sugar limits are set to below 50 mg/dl or above 400 mg/dl.

• To remove the instruction from the order, click to uncheck the item.

• To change the lower or upper limits, type different values.

4. To generate a chart from the Department of Endocrinology, displaying insulin doses based on the patient's carbohydrate intake and glucose level, click View Algorithm (ALT+V).

• The default example does not use the entries made for the current order. To update the chart, click the field, then backspace or delete to erase the default value, and type:

1. To reflect the order for the patient, update the Target, Carbohydrate Ratio, Sensitivity, and Round Down to values.

2. To set the carbohydrate intake amounts for which you want to display doses (column headings in the chart), update the Carbohydrate Intake, Values 1 through 4, in grams.

3. To set the blood sugar levels for which you want to display doses (rows in the chart), update the Blood Sugar range minimum, maximum, and intervals (mg/dl).

4. Click Re-Calculate.

5. To generate a paper copy of the completed chart, click Print.

6. Click Ok to return to the algorithm entry form.

5. Click OK (ALT+O) to return to the medication order form. Reselect Insulin Algorithm from the Dose drop-down list to change the data for the calculations.

6. Select a frequency.

7. Click OK (ALT+O).

• The nurse is prompted to enter the patient's current blood glucose and carbohydrate intake when administering this order using the eMAR (electronic medication administration record). The eMAR calculates the dose to be given, and is used to monitor and document the administration.

• See also: Ordering medications