NSW Subcutaneous Insulin Prescribing Chart

Aim

To standardise an adult subcutaneous insulin chart and minimise risks in insulin prescription, administration and documentation.

Benefits

The chart combines prescription and administration with blood glucose, ketone monitoring and glycaemic management. It links all the necessary information for glycaemic management in one document.

The chart is designed to minimise delays in management decisions and provide clinicians with clear guidelines for:

  • Insulin prescription and administration
  • Glycaemic management
  • Safe supplemental insulin use.

The chart includes:

  1. Regular, supplemental, once only, and telephone orders
  2. Monitoring for blood glucose levels (BGLs) and ketones
  3. Glycaemic management guidelines to support clinicians that may not have access to local guidelines, policies or specialist services. 

NB: Guidelines are intended as a guide to providing quality patient care. They are not intended to replace individual clinical judgement.

Summary

Standardising prescribing charts provides a common tool for clear communication, documentation, interpretation and administration of insulin orders across NSW. It facilitates a uniform approach to training and education, which is better for patient care.

The inclusion of daily blood glucose and ketone monitoring allows a trend of clinical data at a glance, and enables staff to refer to recent readings more easily when prescribing and administering insulin doses.

Doses supplied by telephone order, supplemental doses and once-only orders are all recordable in this single document.

The chart provides best-practice guidelines for glycaemic management to assist clinicians that may not have immediate access to these, or access to specialist services.

The provision of guidelines at the bedside, linked to standardised monitoring and prescribing, are intended to minimise delays in management decisions and to provide better management of subcutaneous insulin, minimise the risk of patient harm, and provide safer patient care.

Background

The subcutaneous insulin prescribing chart was piloted in three sites in 2012. These were Ryde Hospital, Wagga Wagga Hospital, and three wards at Royal Prince Alfred Hospital (RPAH).

An evaluation report of the pilot was completed, which included audit and survey results from each site.

The Medication Safety Expert Advisory Committee (MSEAC) and the State Forms Committee have endorsed the chart.

An implementation workshop was held in October with representatives attending from each LHD. As the chart is a state form, if any LHDs do not wish to implement it then the Director of Clinical Governance is required to contact the Chair of the State Forms Committee.

Partnerships

All LHDs have contributed to the NSW subcutaneous insulin prescribing chart and will continue their partnership with their individual implementation plan.

Key Dates

Pilot Sites

Implementation Sites

The subcutaneous insulin prescribing chart commenced implementation throughout NSW public hospitals after an implementation workshop was hosted by the ACI in October 2013.

Evaluation

An evaluation will be completed during and after the implementation phase.

Related Initiatives

Further Details

Contact

Dr Kerry Newlin
Manager, Endocrine Network
kerry.newlin@health.nsw.gov.au
02 9464 4626

Daniel Comerford
Director, Acute Care
daniel.comerford@health.nsw.gov.au
02 9464 4602

Page Top | Added: 8 November 2013 | Last modified: 16 July 2015

ACI
Status:
Contact:
Dr Kerry Newlin
Manager, Endocrine Network
Email
02 9464 4626
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