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7/3/24 Update to Cerner Home Insulin Pump Documentation, Prescribing, and Inpatient ordering
July 3, 2024

Hey all,

There are several efforts underway to continue improving the safety of patients on home insulin pumps in our health system.

For now, I wanted to make you aware of the following changes that are already live in PROD:

1. We have changed the way we want Home Insulin Pumps documented as home meds

2. We have also made the following changes to the inpatient PowerPlan:
3. Renamed the inpatient PowerPlan to add the word “Home” to improve its searchability: ENDOCRIN Insulin Continuous Subcutaneous Home Pump Orders
4. Changed the order type of inpatient placeholder orders from Medication to Continuous Infusion (e.g. insulin lispro (HumaLOG (Lispro) – Insulin Pump).  They will now appear within the Continuous Infusion section of Medication List and MAR.

Inpatient and prescribing

The draft tip sheet for providers, which is hopefully helpful for anyone working discharge or inpatient verification is here.  The list above is the only inpatient change for pharmacists currently, so it’s not too different from current state:

https://docushare.hhsys.org/dsweb/Get/Document-109406/Home%20Insulin%20Pumps%20at%20Huntsville%20Hospital%20for%20Providers%20-%20new%20version.doc

Home medications and admission rec

The draft tip sheet for anyone documenting home meds or reviewing admissions is here:

https://docushare.hhsys.org/dsweb/Get/Document-109405/Entering%20Insulin%20Pumps%20in%20Document%20Meds%20by%20Hx%20%5brev%202024%5d.docx

Previous “Insulin… Insulin Pump” options have been removed from Document Medication by Hx.  Instead, we will document home insulin pumps using new “Misc Prescription” options found easiest by searching “misc insulin pump”.  Basically, think “insulin pump”.

The basic concept is to unify the way we both document and prescribe insulin for home insulin pumps.  That way, there is no longer a need for Endocrinologists to prescribe using actual insulin records, risking continuation in the hospital.  There is also no longer a need for nurses or TOC staff to complete off those insulin prescriptions and remember to replace them with something else.  Further, if somehow a provider tries to continue one of the “Misc/Other Prescription” options, it will cross over in an Incomplete status and force the verifying pharmacist to correct the orders by placing the inpatient PowerPlan instead.

Moving forward, this Misc/Other Insulin record for insulin pumps will serve as BOTH the prescription for insulin, as well as documentation on the Home Med List that a patient is on a home insulin pump.  They may be used to document on the home med list by nurses, technicians, and providers, and within Discharge Reconciliation can be Continued, Prescribed, or Renewed like other medications.

Example

Details of actual insulin pumps (e.g. model, manufacturer, etc. would be captured on the initial assessment sheet by nursing if the pump is continued): Microsoft Word - Insulin Pump Patient Initial Assessment Sheet 3-2022 .docx (hhsys.org)

Please contact me if you have any questions or feedback!  Thank you to Linh Tong, TOC/Outpatient Pharmacy leadership, Med Safety, and PharmIT for entertaining this concept!  It has received approval from Adult and Pediatric Endocrine service, Nursing Patient Safety Council, and the Outpatient Pharmacy team, but more work is pending with Dr. Jonathan White, Phys track, and Nursing to educate all staff and make further enhancements.

Also, I continue to invite to any pharmacists to get involved in improving this process.  Just reach out to me via e-mail, phone, or text.  A draft patient workflow is at the following link that expresses some of the variables involved: https://docushare.hhsys.org/dsweb/Get/Document-109829/Home%20Insulin%20Pump%20patient%20workflow.pdf.   Some of the biggest overarching action items:

1. Add mandatory home insulin pump assessment for all admitted patients
2. Add automatic provider consults to those trained in home insulin pump management for every hospital, depending on location
3. Improve access to education and tip sheets for nursing, including clarity within Cerner PowerPlans, PowerForms, and iView
4. Improve education on home insulin pumps and continuous glucose monitors (CGMs) for nurses and providers
5. Expand home insulin pump policy on inclusion/exclusion and handling, including for surgical patients

Thanks!

Joseph Ho, Pharm.D.
Clinical Pharmacist - Transitions of Care
Lead Pharmacist - Cerner Pharmacy Education
Huntsville Hospital
joseph.ho@hhsys.org
cell: 504-214-7705
office: 256-265-9854