Transcription of ADULT INSULIN PRESCRIPTION AND BLOOD GLUCOSE …
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ADULT INSULIN PRESCRIPTION AND BLOOD GLUCOSE …
ADULT INSULIN PRESCRIPTION AND BLOOD GLUCOSE MONITORING CHARTWardWard WardCONSULTANTDATE OF ..yearPlease affix Patient s label herePATIENT OF NUMBER ALLERGY or ADVERSE EFFECT Medicine/OtherIf none known tick box EffectDo not use this chart for patients who have diabetic ketoacidosis (DKA), or for maternity patients- separate charts available If self -administering ensure assessment sheet is section must be completed and signed by a prescriber or Pharmacist before a drug is givenONCE ONLY PRESCRIPTIONS OF INSULINDateTimeInsulin typeDoseRoute Prescriber s signaturePrint nameGiven byTime givenunitsSCunitsSCunitsSCunitsSCONCE ONLY PRESCRIPTION OF GLUCAGON (Prescribed by Dr)DateTimeMedicineDoseRoute Prescriber s signaturePrint nameGiven byTime givenGlucagon1mgIMONCE ONLY GLUCAGON and Fast Acting GLUCOSE gel (PGD)For nurse administration under Patient Group Direction (Trust wide PGD in place)Date administeredTime administeredNurse signatureNurse nameGlucagon1mg IM injectionAccording to PGD instructionsGlucose gel(Glucogel/Dextrogel)2 tubes of 25g orallyAccording to PGD instructionsDecember 2013 review December 2015 NUH02231 SIAP4-J5626 ADULT INSULIN PRESCRIPTION Chart 107/01/2014 17:062 MANAGEMENT OF HYPERGLYCAEMIA (HIGH BG LEVELS) IN PATIENTS WITH DIABETES Pre-meal BLOOD GLUCOSE (BG) > 11mmol/L review the patient, their BG monitoring record and increase BG monitoring.
injection According to PGD instructions Glucose gel (Glucogel/Dextrogel) 2 tubes of 25g orally According to ... Repeat step 1 up to 3 cycles, if still <4 contact doctor. Capillary/fingerprick (CBG) or laboratory blood glucose <4mmol/L ... If patient is self-administering, document with relevant administration code, and countersign your initials ...
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