7 Recommendations for Coordinating Insulin Administration, Nutritional Therapy

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ECRI Institute's patient safety organization released a notice on insulin administration.

When nutrition changes for a diabetic patient, his or her insulin regimen may inadvertently remain unreviewed or unchanged, according to ECRI. In addition, patients also often have different practitioners for nutritional therapy and insulin, posing a risk to patient safety.

The alert, "It's More Than Counting Carbs, It's Communication and Coordination: Insulin Administration and Nutritional Therapy," discusses patient safety issues for patients receiving enteral or total parenteral nutrition and insulin. The report includes seven recommendations for coordinating insulin administration and nutritional therapy:

1. Address the coordination of care through policy- and systems-level solutions. Ensure communication among providers is open, consistent and clear.

2. Consider the use of systems such as electronic medication administration records or electronic health records to verify the accuracy and appropriateness of insulin and nutrition orders.

3. Empower staff members and create systems to ensure regular review of the patients' nutrition and insulin orders for accuracy.

4. Anticipate changes in requirements, and consider all sources of dextrose and medications when calculating insulin requirements.

5. Coordinate among the care team to remain aware of enteral feedings.

6. Consider establishing an inpatient diabetes consultation team of physicians and nurses for complex cases.

7. Use standardized, structured insulin orders and algorithms to determine the patient's required dosage.

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