Hello All,

Our current orders for long-acting insulins include an order question prompt "If NPO:" with options of Give dose as ordered, Contact provider for instruction, Decrease dose by: 25% or 50%, and Other (see instructions). The response defaults to "Decrease dose by 50%." The orders also have admin instructions that state "If the patient has a future NPO order, use the reduced dose starting 12 hours prior to the NPO order. Continue the reduced dose while patient is NPO. Resume full dose when a diet is resumed."

We have a large number of safety events reported in which a patient has an order to be NPO at 0000, but receives the full dose of the long-acting insulin at 2100 despite the order question indicating a 50% reduction in dose.

Have other facilities implemented decreased long-acting insulin doses for all patients with NPO orders? What has been put in place in the EHR to ensure the decreased dosing is implemented? Or is a new order from the provider required?

Appreciate any insights. Thanks in advance!