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Insulin Pumps in the hospital setting

Nov 12, 2010

Do you find the questions revolving around insulin pumps in the hospital a new series of challenges? Questions such as: When should they be utilized or removed? When should a patient be able to reestablish pump care when hospitalized for surgery? Should the patient be able to wear the pump during the surgery? And if so, should the basal rates be changed? Is it all right for a patient in the psychiatric ward to continue to manage their own pump therapy if not suicidal?

These and many other questions come up as more and more individuals with type 1 and type 2 diabetes are entering the hospital and wanting to maintain connection with their insulin pump. Another challenge is that many of the hospitalists are unfamiliar and uncomfortable with pump therapy. Nurses change positions within the hospital and turnover can create a gap in knowledge about diabetes itself and an array of misunderstandings about insulin pumps as a tool to manage diabetes.

Education on the care of the patient with diabetes on insulin pumps in the hospital setting should be available to hospitalists, nurses and other staff responsible for the care of the patient. Mandated educational tools that are available on demand (computer access, manuals etc) should be implemented for new hires. Patients should be advocates for themselves whenever possible, and as educators, we should encourage that!

If a patient needs to come off pump therapy, asking the patient what their bolus doses and basal rates are during the admission process would greatly enhance the individualization, rather than defaulting to protocols. The latter being required when a patient is unable to communicate their usual insulin dose.

If patients are allowed to maintain their pumps during their hospital stay, and have a pump knowledgeable team available, adjustments can be readily made resulting in allowing a proactive approach to management of glucose values in the hospital rather than antiquated and arbitrary drip protocols that act retrospectively.

What is your hospital doing to facilitate patients’ use of insulin pumps during their hospital stay? Are you providing continuing education to staff to enhance the effectiveness of patient pump utilization and quality of care? Is the education mandated for any particular staff? Please share your stories and any resources you may have found useful!

5 comments

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  1. Feb 16, 2015

    We are interested in developing a policy to instruct staff on the use of insulin pumps during surgery as well as steps to take if the pump is not going to be used during surgery. Does anyone currently have a policy in place that they could share?
  2. Dec 22, 2010

    I am just starting a pump program at our hospital and have been looking at insulin pump polcies for inpatient and outpatient for our Diabetes Education Program. I have a group of policies from a sister hospital. I would like to send them to anyone who is interested to help me read them and if anyone would be willing to share their pump policies with me so I can do some comparisons. None of us have the time or energy to be wasting when someone has already done a policy or a process. There are way too many people with diabetes who need to be safely taken care of. Thank you for the geat organizaition we have.
  3. Dec 01, 2010

    I recently did a talk on "Insulin pumps and CGMS: Need to Know and Nice to Know" for Diabeted Education day at our hospital. The audience was nurses, RDs, APRNs, and some other professionals. I started with the benefits of the systems so people would understand the importance of these technologies. I focused on what parts need to keep and what to toss if they need to be removed. I reviewed hospital protocols for pumps (which was a project I worked on January 2008 when I first arrived at this worksite). What the pump and CGMS components look like for the 3 pumps and 2 CGMS we (Endo and Diabetes practice) recommend, basic programming, how to check for last bolus, basal rates and bolus settings, etc. We also have been educating our pt. and have developed a handout for "Pump Failure" including basal insulin (Levermir or Lantus) doses, and being sure the pt. has rx for these and syringes if needed. So our pt. should know their off the pump insulin. We also will have an RD/CDE in the hospital starting in January 2011 who wears an insulin pump. She will educate the staff as well as the pt.
  4. Nov 19, 2010

    To answer your question regarding how much a patient should know prior to pump therapy: I don't think there is a perfect answer. I have come to view the pump as not a "reward for understanding", or for "having reasonable BG control", but another tool to help provide a better quality of life for the individual with type 1 diabetes. I have several patients who have developmental delays, who can work the pump quite well, and put in their carbohydrates reasonably, but could never do the calculations required to management their diabetes as well without the pump. And there BG control is much better with pump therapy than before. An individual may also be quite articulate at the pump in the first 6 months or year, and then become complacent, forgetting how to change basal rates, as they feel comfortable with the ones they have. When they use the automatic calculations, they also forget what their ratios are, as they never really think about them anymore. So it makes the patient appear "pump stupid" when they use the tool quite effectively. Refreshers whenever we can(inpatient or outpatient), are always helpful!
  5. Nov 15, 2010

    We feel it is in the patients best interest to maintain the pump therapy throughout their hospitalization. I work in a children's hospital so we have the parents sign an 'agreement" stating they will stay at the bedside to assist with managing the pump and will not do anything unless it coincides with the endocrinologists orders. We also encourage the physicians and staff to order a consult for our diabetes education department and we try to get to the unit first thing in the morning to ensure the child/parent has appropriate supplies for set/reservoir changes and to check the settings to ensure they coincide with what the physician has written in their orders. We have a full policy that advises the RN to check the sites, check bolus history q shift & prn and to consult CDE's as needed. As far as education for RN's, we have 3 or 4 pump companies attend an annual staff meeting and we give each of them 15 minutes to do a quick "how to" demo on their pump : how to review and modify basals, how to give a bolus, how to check bolus history, how a set is changed. It's very very basic. We also offer quarterly "Diabetes Day" trainings that RN's that work on our diabetes floors are required to attend. But the bottom line is the staff rely heavily on our DE department to assist them with the pumps. We assess parents knowledge and if they need it either we give them a very basic refresher course (1 hour or so) OR we've actually had a rep from the pump company come in and do some training in some extreme cases where the parent had poor understanding.

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