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| Sharp Healthcare System Insulin U-500 P&P and Order Set Cerner Go-Live Tuesday, April 24 |
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Situation:
A patient may state that they take Regular insulin at home when actually they use U-500 insulin. At home a majority of patients use a U-100 insulin syringe to administer U-500 insulin. This may mislead staff when the patient cites the U-100 syringe scale rather than the actual units of U-500 insulin as the insulin dose (i.e. 20 units on a U-100 syringe when the actual dose is 5X that amount or 100 units of U-500).
Background Information:
Occasionally a patient can develop such resistance to the effect of insulin that daily doses of several hundred units are required. Use of standard insulin (U-100) becomes problematic when the total daily dose of insulin exceeds 200 units/day. The volume of insulin required becomes so large that it is painful for the patient to inject and absorption becomes unpredictable, resulting in poor glycemic control.
Assessment:
Humulin R U-500 (highly concentrated) insulin is 5X more concentrated than standard insulin and is especially useful for the treatment of patients with marked insulin resistance, as the large dose required can be delivered in a more reasonable volume for subcutaneous use.
Recommendation:
A SHC system P&P and Cerner order set has been developed specifically for
U-500 insulin use in the hospital setting.
Independent verification of this subcutaneous insulin is required.
Use of U-500 order set is required. No sliding scales.
AC meals or one time dose.
Patient is prohibited from self-dosing this home medication per hospital policy.
Medication must be sent home or to pharmacy for storage.
Automatic consult with the pharmacist and the diabetic nurse specialist when U-500 is
ordered. A Pharmacist will confirm home dose and enter in Cerner under "Document
Medications by History".
To avoid confusion it is critical that the inpatient prescription describes the dose both in units and volume.
The dose(s) will be prepared in the pharmacy in a 0.5mL or 1mL syringe (depending on the dose) and delivered to the unit.
Type Insulin into the Orders Search box and choose Insulin U500 Highly Concentrated
References: 1. Cochrane, E. et al. The use of U-500 in patients with extreme insulin resistance. Diabetes Care (2005 ) 2:1240-1244.
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| Bumetanide (Bumex) Injection and Other Meds on NATIONAL BACKORDER |
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Bumetanide (Bumex) vials for injection are on NATIONAL BACKORDER.
This is a NATIONAL SHORTAGE. The expected release date is mid to late May.
Pharmacy has already placed multiple backorders, so it will be auto-shipped as soon as it becomes available.
Please consider using Bumex tablets whenever possible.
However, if the oral route is not available, the Pharmacy does have plenty of Furosemide (Lasix) injection on hand.
Remember: 1mg Bumex IV = 40mg Lasix IV
Other medication shortages to keep in mind:
Fosphenytoin (Cerebyx) injection
Metoprolol (Lopressor) injection
Naloxone (Narcan) injection
Pitressin (Vasopressin) injection
Sodium Bicarbonate injection
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| Calendar Updates |
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May 11 - Rose Garden Memorial for Dr. Marxen
June 13 - Concert under the Stars
June 15 - Dancing with the Doctors
September 19 - General Medical Staff Meeting
December 4 - SGH Medical Staff Holiday Party
Watch for specific details on each event or call Lesley Bradley at 619-740-4145 or email her at lesley.bradley@sharp.com.
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