Documenting insulin pumps

[mmc51264, BSN, MSN, RN]

Not sure where to post this, but starting here. I am a floor nurse, on an ortho unit. Because fo the size of the hospital, we have "champions" in areas so the we don't need extra people. I am the diabetes champion for my unit. I am also an MSN-Informatics student. My area of interest is clinical ed of staff regarding Type 1 patient in the inpatient setting.

I am working on a project so that we can make it more user-friendly to document insulin pumps. It is a teaching hospital, so we have a lot of residents that don't know much abotu diabetes in general let alone the difference between T1 ans T2. The pumps-whew-right over their heads.

How do all document pumps? I have to help figure out how to explain continuous basal rates, changes in basal rates, and then how to document mealtime boluses from the pump. Not to mention documenting sites, site changes, how the scan the insulin for boluses. Now we have had our first patient with a Dex. Have to explain what it is and then meed to ake sure we need to document sites/site changes.

It is all so overwhelming. Very few people grasp what I am trying to explain. The only reason I am so familiar is that I have 2 sons with T1 and both wear a pump and a CGMS.

Nurse are smart people. It is SO hard to give crash courses in this. Any suggestions? How do you document in your EHR?

I am sitting for my CDE this summer, but how does one become a CNS to educate staff? Our inpatient educator is THE BOMB, but I know she is overwhelmed and I want to help.

[Sha-Sha RN]

My hospital still documents on paper and there is a special flowsheet to document the FS, bolus amounts and basal rates for pumps. There is an order in the EHR for the pump settings but monitoring is done on paper. I'm sure that flowsheet will have to be made into an electronic version once the Nurses start to document directly into our EHR.

[mammac5]

We use an Insulin Pump Self-Management agreement. A provider has to deem the pt is fully capable of self-management...we determine this with various questions and we expect the pt to show us his/her basal settings, tell us how many units:grams of CHO they bolus, what is their correction factor, etc.

They sign the form that states Nursing will check CBGs on our machine, the pt will inform the RN how many units will be bolused based on the CBG and anticipated PO intake. That is scanned into the chart.

There is a section in our EMR (under therapeutic monitoring) where the bolused are charted by RN.

The basal pump settings are documented under home meds, then that is carried over to curren meds so this is in the EMR. We change this if we adjust the rates while in hospital so the correct doses/rates carry over at discharge.

We have a Diabetes Mgmt Team (NPs/PAs) who see most of the pts with pumps which means not everyone has to be familiar with them. We are available to RNs (even overnight call) when they have problems, don't know where to document, etc., so they can contact us.