Description

This clinical documentation form is an essential tool for healthcare professionals managing insulin administration and blood glucose monitoring in adult patients. Designed for use in hospital settings, it provides a comprehensive structure to ensure accurate and effective diabetes management.

Key Features

• Patient Identification: Includes sections for recording patient details and diabetes treatment history, facilitating personalized care.
• Insulin Order Recording: Features tables for documenting routine, supplemental, and emergency insulin orders, with pre-printed "UNITS" and meal times to streamline dosing accuracy.
• Blood Glucose Monitoring: Offers prompts and alerts for blood glucose levels outside the target range, enhancing patient safety.
• Guidelines for Glycaemic Events: Provides instructions for managing hypoglycaemia and hyperglycaemia, including insulin dose adjustments and carbohydrate administration.
• Multidisciplinary Communication: Includes areas for documenting communication among healthcare providers and a section for pharmacy review dates.

Usage Instructions

• General Monitoring: Contains instructions on blood glucose monitoring frequency and guidance on when to notify medical staff or seek specialist advice.
• Completion: Emphasizes the importance of accurate and legible completion, adhering to local hospital protocols.

Availability

While primarily a paper form, digital versions may be available in some systems, ensuring continuity during system downtimes. It is commonly used across various hospital departments, including acute, non-acute, and mental health facilities.

Development and Training

Developed by clinical networks with input from healthcare professionals, this form is grounded in best available evidence and regularly updated to reflect current practices. Implementation is supported by comprehensive training resources, including user guides and instructional videos, to ensure correct usage by hospital staff.