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Top Conversations: Insulin Needles, Hypoglycemic Prevention, Inpatient Consults

Sep 19, 2017

Each quarter we recognize the threads that generated the most discussion among members on MY AADE NETWORK. These members posted to the site, producing threads that had the most views and replies...and generated helpful, insightful, and/or eye opening comments for the entire community.

Congratulations to this quarter’s winners:

  • Patricia Cronk, RN, BSN, CDE, CRRN
  • Amy Freeman, CDE, LD, RD, RDN
  • Shanell Schulz, CDE, RD, LD

Commenter: Patricia Cronk, RN, BSN, CDE, CRRN
Thread: 6MM Insulin Needles
Topic: Inpatient Management COI Forum

I see a teaching opportunity here for one and all. Shorter needles have been available for a few years now. They can prevent insulin being given “IM” and are more comfortable. We have done re-instruction about q 12 months or so, for correct insulin injection technique for staff nurses. Lilly professionals – RNs, come and instruct all shifts/traveling unit to unit. We use insulin pens in our hospital, but still, you might explore the staff instruction available to you through Lilly, Novo, or BD. Our instruction always yields clarification and correction of misinformation and is met with appreciation by nursing staff (and it is free).

 Shanell Schulz, CDE, RD,LD
Thread: Hypoglycemic Prevention Policy
Topic: Inpatient Management COI Forum

I was apart of a similar team two years ago. We created a Hypoglycemia Standing Order. If you aren't familiar with Standing Orders, these are orders given by physicians in written form and if the criteria for the standing order is applicable for the patient, the nurse must follow through because it is a written physician order. Unfortunately, I cannot share the actual standing order form but I can describe our standing order.

We used the ADA standards of care to provide evidence to support it. For every patient that is admitted to the hospital, we have a POCT glucose done, whether they have diabetes or not. A CMP (Complete Metablic Panel) can be used instead of a POCT glucose check, which most patients have anyway. This sets a baseline glucose for their care. This information is then shared with the physician. If the MD would like to continue glucose checks, he will then order further POCT glucose checks. If not, the testing ends here until a hypoglycemic event occurs. If the patient is NPO and has no dextrose in the IV, the nurse is to contact the attending physician and ask if a dextrose solution would be appropriate, explaining that we are trying to prevent hypoglycemia.

Amy Freeman, CDE, LD, RD, RDN
Thread: Inpatient Consults, Bedside RN, and Inpatient RD?
Topic: Inpatient Management COI Forum

In the past, I have developed a Healthstream mandatory assignment for the nursing staff in addition to a survival guide "packet" for the nurses to provide to the patient. The packet included an insulin demo pen with needles, instructions on use, a ball to practice injections with, treating hypoglycemia and warning s/s, the AADE handout on injecting insulin, and a brochure with a referral to our diabetes outpatient education program/support group.

To launch this, I did rounding in-services to all nursing units providing "teaching the teacher," so to speak, guidance. Each month, I checked each unit's packet and updated any expired pens and restocked supplies. Every three months I did the rounding on each nursing unit to make sure the system was working and that the nurses were savvy at providing bedside survival skills. The system worked really well. The main part was to make sure the packet was stocked with supplies and good communication with the staff.

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