Sample Policy: Insulin Pump Therapy in Hospitalized Patients
Purpose
This policy is designed to describe responsibilities of providers caring for patients using personal external
continuous subcutaneous insulin infusion pumps (insulin pumps) during the hospitalization.
Scope


For any patient wishing to use their insulin pump while in the hospital there should be a discussion
with Diabetes Management Service or Endocrine Service about the appropriateness of the patient
managing his/her insulin pump.
Hospitalized patients may only be treated with an insulin pump if they want to use the pump, are alert
and mentally and physically competent to assume complete responsibility for their pump management
according to criteria specified in the consent form.
CONTRAINDICATIONS: The following types of patients should not be treated with an insulin pump: the
patient who is critically ill or has prolonged alterations of mental status (due to illness or iatrogenic),
physically unable to alter the pump settings, suicidal, in diabetic ketoacidosis (DKA), or if the patient does not
have pump supplies in the hospital.
RELATIVE CONTRAINDICATIONS: The following types of patients should use caution when treated with an
insulin pump: the patient who is in acute psychiatric illness (non-suicidal), has short-term alterations of mental
status (e.g. iatrogenic), or has inadequate glycemic control (as defined by the primary team, Diabetes or
Endocrine Consult Service).
Definitions
●
Continuous subcutaneous insulin infusion pump: A battery operated programmable device that
delivers fast or rapid acting insulin 24 hours a day. The insulin is stored in a
syringe/cartridge/reservoir and is delivered through a soft cannula or needle connected to plastic
tubing (infusion set) that is attached to the pump. The insulin pump is usually programmed to deliver
basal and bolus insulin.
●
Basal rate: The amount of insulin that is continuously delivered to maintain a normal glucose
level/metabolic state when not eating. This rate can vary over the course of the day, with different
rates either manually changed or programmed into the pump.
●
Bolus dose: The amount of insulin given for meals and/or correction of acute hyperglycemia. The
patient determines this dose based on the glucose reading, the size of the meal or the estimated
amount of carbohydrates he/she is consuming for a particular meal, and the anticipated amount of
insulin needed to correct the hyperglycemia. This dose is given all at once just as if injected by a
conventional syringe.
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July-10
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Sample Policy: Insulin Pump Therapy in Hospitalized Patients
General Information
●
Treatment by an insulin pump in the hospital requires
o
An order signed by the physician in the computerized prescriber order entry (CPOE) system.
o
A signed patient consent form.
o
Patient Insulin Pump Flow Sheet to be used daily.
o
Ask the primary team to consider either a telephone discussion or a consult from
either the Diabetes Management Service (patients on surgical services) [insert pager
number] or the Endocrine Consult Service (patients on medical or OB-GYN services)
[insert pager number].
●
The patient maintains his/her own insulin pump while hospitalized unless contraindications
are present (see above).
●
Disconnection from the pump or discontinuation of insulin infusion for more than one hour will
require an alternative insulin delivery. Primary team should be contacted for instructions.
●
The insulin pump should be temporarily disconnected from the patient for showering/bathing
if it is not waterproof.
●
The insulin pump should be temporarily removed for MRI and CAT scan tests. If the procedure will last
more than an hour, alternative insulin delivery should be considered. The treating physician should be
notified for instructions.
●
Inpatients undergoing general anesthesia should be evaluated by the Diabetes Management Service
or the Endocrine Consult Service prior to surgery. These consultants will determine the
appropriateness of intraoperative and postoperative continuation of the insulin pump.
●
The patient, bedside nurse, and primary team should continue to assess, on an ongoing basis, the
patient’s level of consciousness and appropriateness to continue use of the pump.
●
The patient needs to change the infusion set and reservoir at least every three days or earlier. More
frequent changes may be needed if
o
Bleeding is noted at the site;
o
The site is red, swollen, or warm to touch;
o
There is pain at the delivery site;
o
A “no delivery” alarm without tubing problem occurs; or
o
Two glucose readings are above 300 mg/dL in a four-hour period.
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Sample Policy: Insulin Pump Therapy in Hospitalized Patients
Policy
●
●
On admission to [insert hospital name], the physician needs to be notified that a) the patient has an
insulin pump, b) the physician (primary team) is responsible for obtaining a signed patient consent
form for use of the pump, and c) pump orders are required [insert link to order set for subcutaneous
insulin pump].
o
All patients using an insulin pump should be identified on admission by nursing and physician
staff.
o
Notify pharmacy of insulin pump. A pharmacist will need to assess patient’s own insulin.
The patient should be provided with Patient Self-management of Insulin Pump Consent Form for
them to review prior to the physician having them sign the form. The consent must be signed by the
patient and the physician of primary care team if the patient is to continue the insulin pump
treatment during the hospitalization.
o
●
Check to make sure there is a physician order for use of the pump in the hospital.
o
●
Physician orders are needed to allow use of insulin pump. An insulin pump order template is
available in CPOE system.
At a minimum of every 8 hours, the patient’s ability to manage the pump needs to be assessed. The
insulin pump needs to be discontinued by the patient, family, or physician if the patient has a
contraindication to the pump (see above).
o
●
The patient can review the document while they are waiting for the physician to address their
questions and ask them to sign the form.
If the patient cannot assume full responsibility for the management of the pump, it should be
discontinued and alternative insulin orders obtained.
Documentation
o
Document the insulin pump is being used and is infusing upon admission to [insert hospital
name].
o
Document in the flow sheet every 8 hours an assessment of the patient’s level of
consciousness, orientation, and presence/absence of insulin pump contraindications (e.g., risk
of suicide).
o
Give patient the “Patient Insulin Pump Flow Sheet” daily. This is for documentation of
the type of insulin being used, the basal rate, bolus doses of insulin, and blood glucose
readings.
o
Document assessment of infusion site each shift.
o
Document site rotation and change of insertion site and tubing at least every 72 hours.
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July-10
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Sample Policy: Insulin Pump Therapy in Hospitalized Patients
˗ A notation should be made in the flow sheet and on plan of care every shift indicating
that the patient has no contraindications to pump use (e.g., they are awake, alert,
oriented, not suicidal).
˗ The patient, upon signing the consent for pump use in the hospital, is required to
record the amount, time, and type of insulin that she or he is administering on the
Patient Insulin Pump Flow Sheet.
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More information is available at www.onepenonepatient.org
July-10
Page 4 of 4