All IV Push insulin orders will be automatically converted to IVPB at order entry/verification.
Refrigerator item
High Alert Drug: Insulin
• Two RNs independently verify type & dose prior to administration.
High Alert Drug: Insulin (IV)
• Two RNs independently verify type & dose prior to administration. • Administered via IV pump; Not to be given by IV push for any indication.
High Alert Drug: U-500 Insulin
• Pharmacist confirms home dose with patient. • Electronic order entries are double checked by another pharmacist or RN. • U-500 insulin is stored in the pharmacy. • Scheduled doses are drawn up by pharmacy and double checked by 2 pharmacists or pharmacist and RN prior to dispensing. • Documentation log is completed by pharmacist.
Per policy, these medications require cardiac and/or special monitoring. (KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes
CCU, OR, PACU, CCL, ED
PCU
2N (Tele)
1N (Tele), 3N (Tele)
Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N)
BirthPlace
SNF
ICS
OPS
insulin regular (HumuLIN R) IV Infusion for DKA (NOT IV push)
Y
Y
N
N
N
Y
N
N
N
insulin regular (HumuLIN R) IVPB for Hyperkalemia Key: Order set
Y
Y
Y
Y
N
N
N
N
N
Per policy, orders for these non-formulary agents will be changed to formulary equivalents.
Non-Formulary Agent
Formulary Equivalent
insulin regular, human (NovoLIN R)
insulin regular, human (HumuLIN R)
Per policy, these hazardous drugs have special waste requirements.
Generic (Brand)
Waste Requirements
insulin regular (HumuLIN R, NovoLIN R)
Contains M-Cresol ⇒ BLACK BUCKET
2023 American Geriatrics Society Beers Criteria® for potentially inappropriate medication use in older adults.
Medication:
insulin regular (HumuLIN R)
Criteria 1: Potentially inappropriate medication use in older adults. (Table 2)
Drug(s)
insulin, sliding scale (insulin regimens containing only short- or rapid-acting insulin dosed according to current blood glucose levels without concurrent use of basal or long-acting insulin)
Rationale
Higher risk of hypoglycemia without improvement in hyperglycemia management regardless of care setting. Avoid insulin regimens that include only short- or rapid-acting insulin dosed according to current blood glucose levels without concurrent use of basal or long-acting insulin. This recommendation does not apply to regimens that contain basal insulin or long-acting insulin.
Recommendation
Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong
Refrigerator item
• Administered via IV pump; Not to be given by IV push for any indication.
• Electronic order entries are double checked by another pharmacist or RN.
• U-500 insulin is stored in the pharmacy.
• Scheduled doses are drawn up by pharmacy and double checked by 2 pharmacists or pharmacist and RN prior to dispensing.
• Documentation log is completed by pharmacist.
(KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
IV Infusion for DKA (NOT IV push)
IVPB for Hyperkalemia Key: Order set