We have seen a recent up-trend in hypoglycemic events for patients when subQ insulin was continued after tube feeds were held. Under our current practice we have note in the admin instructions for nursing to “hold subQ insulin if tube feeds are held” for these situations. We are hoping to add additional safety measure to encourage providers to hold insulin orders when tube feeds are held and/or draw nursing attention to this practice. I am looking for any other ideas or solutions that other institutions have implemented that may be helpful. Thank you in advance!

We are having issues with nurses not hanging D10 when tube feeds are stopped and patient received insulin. We have a request to document tube feeds on the MAR in order to facilitate clinical decision support.

If you have tube feeds on the MAR and use Epic, please provide information on your Epic build or provide a contact that I can use to help us with this.

Thank you,
Ann

We have an order set for insulin that contains orders for hypoglycemia treatment and also an order for D10 for hypoglycemia prevention. If the patient receives NPH insulin and continuous tube feeds are later stopped, the nurse is to hang D10 at the same rate as the feeding rate. The D10 order may be placed days before the tube feeds are stopped for procedure or other reason. Our nurses are not hanging the D10 in all cases and we see 1-2 safety events each month for hypoglycemia due to this.