Question on Pediatric Insulin Administration

Wow. At my facility we have endocrinology fellows that typically determine the insulin orders. However, for our knowns, they may have in their progress note "continue following this X plan from home" but unfortunately, it is currently against hospital policy for their to be a standing order for insulin so they are not allowed to just write an order to continue following the home regimen.


Does your facility even use fellows? I would think it'd be easier to get a hold of the fellow than the attending.

I think that there will have to be some clear cut guidelines if I am able to institute a standing order. For example, all insulin doses would be checked with another RN to verify accuracy, and the doctor would still be notified when the pt has ketones, as well as being notified if blood sugar goes above a certain pre-determined amount.

Sorry, let me re-explain. All I'm asking is for those that are known diabetics with a home protocol to be allowed to have that exact same protocol as a standing order for their hospital stay. It might say "follow pt's home sliding scale of.... and follow pt's carb to insulin ratio of....." I know this is a very differnt idea for peds, But Seattle Children's currently does it, as well as Sutter Medical Center in Sacremento. From the detailed examples I've seen for both hospitals, these order sets are a little more involved than a simple one time order would be, but I believe that if the patient is getting their insulin much closer to when their blood sugar was originally checked it will lead to much better coverage.