How to document insulin

Sliding Scale #

1. In the Order Code Setup screen for regular insulin (and all insulin order codes that can be used for Sliding Scale Insulin), select the option to Enable Sliding Scale Insulin Instructions. See the red box in the image below.
   
2. On any insulin order for which sliding scale is desired, enter the order code and select the correct insulin result.
3. Enter the frequency/schedule that is desired and then click on the Sliding Scale Insulin Instructions button.
   
4. The Sliding Scale window will display. You may have several standing Sliding Scales available. In the example below, the Standard Sliding Scale was chosen.
5. Click Save.
   
6. The Special Instructions window will now have all of the information from the Sliding Scale Window.
   If this is not desired, click on the Clear Sliding Scale Instructions button.
   
7. Continue and save the order. In RxConnect, this order will display like this to the pharmacist.
   Note: The pharmacist should manually type in "1" in the Total Dosage field, click on the Calc Count button, then manually type over what is in the Dose field with "Sliding Scale" for something similar. myAvatar sends this order as a Sliding Scale, and because of this, it will leave the units blank on the eMAR and force the nurse to indicate how much to administer.
   
8. The pharmacy order has now been saved and myAvatar eMAR now presents the following screen to the nurse.
   Caution: The Dose field must state "Sliding Scale" or something similar, and not have any dose calculations in it. The pharmacy must manually ensure that this is the presentation before saving the order.
   
9. If a nurse scans a bar code or manually selects the time to administer the medications, this screen will be presented:
   
10. You may need to click on the SSI field to get to the detail of the Sliding Scale instructions. Clicking this button brings up the following screen:
    
11. Nursing staff should enter the Blood Glucose level and then press Enter.
    
12. This automatically highlights the number of units that should be administered. Click Select Dose and the number of units are shown in the quantity (Qty) field.
    

Non Sliding Scale

If the Sliding Scale is not being used for insulin administration, the nurse will need to:

1. Click on the default administration event.
2. Click on the additional data and enter the patient's Blood Glucose value.
   
3. Enter the number of Units that were administered.
   
4. Select Accept Administration Information Entered.
5. Clear any warnings.
6. Click on OK.
   

Schedule known dose insulin order

1. In this case, you would select the insulin desired and then enter the amount at the selected time, as well as the frequency/schedule desired.
   
2. This appears to the pharmacist as in the screen below. The pharmacist must enter the number of units desired and then click Calc Count. All of the information on the screen below will then default.
   
3. If the pharmacist has the Rule Warning set to On, the system will warn of any values of the limit set in the pharmacy. In this case, the rule was set to 5 units. Consequently, anything over 5 units will require a double-check by the pharmacist.
   The following rule warns of anything over 101 units:
   
4. You much change the second line to be the number of acceptable units. Anything above this, will cause the system to stop the pharmacist. Placing the highest amount usually ordered for a non-sliding scale order is best.
   
5. When the order is saved, the eMAR will display the following to the nurse:
   
6. Upon scanning the NDC number on the bottle, or manually clicking on the time to administer the medication, the following screen will appear:
   
7. The nurse will need to:
   1. Change the number of units that were administered (or accept the default amount).
   2. Select Accept administration information entered.
   3. Clear any warnings.
   4. Click on OK.
      
8. Upon saving the administration, this is what appears to the nurse on the eMAR.