National subcutaneous insulin chart for acute hospitals

The national subcutaneous insulin chart is designed to:

• Link the prescribing of subcutaneous insulin with administration and recorded blood glucose levels (BGLs)
• Provide forcing functions to reduce the use of non-standard abbreviations and non-standard dosing regimens
• Provide guidelines for action to be taken in the event of BGLs reaching levels which indicate a medical officer should be alerted and action taken
• Prompt daily review and adjustment of insulin doses in response to BGLs.

The chart has a number of safety features and enabling functions including:

• Notification prompts for BGLs outside of target range
• UNITS pre-printed
• Discouragement of stand-alone subcutaneous ‘sliding scale’ insulin
• Ability to prescribe supplemental (or correctional) insulin
• Multidisciplinary communication documentation
• Recommended initial insulin infusion rates
• Guidelines for the management of hypo and hyperglycaemia
• Insulin administration associated with meals by pre-printing meal times.

The national subcutaneous insulin chart has been piloted in public and private hospitals in two waves. The safety performance of the subcutaneous insulin chart points to 35 areas of positive performance (of statistical significance) which led to improved management of BGLs in hospitalised patients.

The evaluation report makes a number of recommendations, including the monitoring of six areas of performance by health services which would like to implement the subcutaneous insulin chart.

A sub-acute cohort is currently trialling a chart with modified recommendations to the management of patients with abnormal BGLs more suited to the sub-clinical setting.

National subcutaneous insulin chart for acute hospitals

National subcutaneous insulin chart evaluation report – acute hospitals (PDF 897KB) (Word 6MB)