To set up the sliding scale dosing:
If you haven't already, click to select Sliding Scale from the Dose drop-down list.
For Insulin Regular or Insulin Lispro orders with defined dosing sliding scales (Usual Dose, Low Dose, or High Dose), the dosing is locked; edits are not allowed. If changes are needed, click Cancel (ALT+C), then search for insulin. Select Insulin Regular Custom or Insulin Lispro Custom as needed.
For some medications, the values for a routine scale are already entered. If editing is available:
To enter a tighter sliding scale, click Clear Scale (ALT+C), then update the fields (see next step).
To restore default values, click Default Scale (ALT+D). If more than one default is available, click an option when prompted, then click OK.
If needed, type a value or range for the dose-determining test result in the left field of a line, and the responding dose in the right field. Complete as many lines as needed to designate the entire scale.
For insulin, by default, 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.
Click OK (ALT+O).
Select a frequency or Other.
If needed, order a loading dose. See Ordering a Loading Dose.
The loading and maintenance dosing for a single medication can be ordered on the same form. The two are separated for transmission to the pharmacy system, with a one-time (x1) frequency for the loading dose. You must delete both orders before signing to prevent ordering the medication. See Deleting Orders.
For patients on insulin, the option for an NPO dose is not available for sliding scale dosing. The NPO dose is an option for fixed dosing only.
For patients on insulin, a consequent order for laboratory glucose monitoring is added automatically . If the dosing is sliding scale, a glucose level is ordered if the fingerstick at bedside is under 50 or over 500. Providers are prompted to add an order for hemoglobin A1c with the first insulin order of the visit if there has not been a result recorded in the previous 60 days. These associated orders are listed in the orders for this session, and can be edited or deleted before signing. As with any order, they can also be edited or discontinued after signing. They are listed in the active Laboratory orders. See Consequent Orders Overview.
See also Writing a medication order