Download Admitted Patients with Acute Myocardial Infarction with Diabetes Pre-printed Order Sheet

Admitted Patients with Acute Myocardial
Infarction with Diabetes
Pre-printed Order Sheet
These orders are to be used as a guideline and do not replace sound clinical judgment and professional practice standards.
Patient allergy and contraindications must be considered when completing these orders.
Standard orders. If not in agreement with an order, cross out and initial.
Requires a check () for activation.
Drug Allergies
►
ORDER
TRANSCRIBED
AND
ACTIVATED
%
MEDICATION ORDERS
TO BE INITIATED OR DISCONTINUED
Þ
GENERAL ORDERS
TEST
DONE
PAGE 1 OF 1
DATETIME
------------------------------------ ------------------------------------TARGET:
Pre-meal blood glucose of 5 - 10 mmol/L.
DIAGNOSTICS/TESTS:
Patient’s Height ���������������������������������������� cm
Patient’s Weight ���������������������������������������� kg
Hemoglobin A1C (do on admission bloodwork).
Blood glucose monitoring QID x 48 hours and then
reassess.
MEDICATIONS:
gliclazide
_____________________________________________________
glyBURIDE
__________________________________________________
metFORMIN
Insulin
Other
DIET
100 mmol Na, modified fat.
Controlled Carbohydrate.
_________________________________________________
________________________________________________________
_________________________________________________________
TEACHING
Give patient the Type 2 Diabetes Learning Package
(W-00086) and review as per facility guidelines.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
CONSULTS
Consult Endocrinology/Internal Medicine for patients
with poor glycemic control (blood glucose constantly
greater than 12 mmol/L, new insulin starts, or marked
changes in discharge insulin dosages).
Insulin correction dose scale based on blood glucose
monitoring (at meal times only).
Dose/Units
Rapid Acting Insulin
(Example: lispro,
aspart) Subcut
10 - 11.9
2 units
12 - 13.9
3 units
14 - 15.9
4 units
16 - 17.9
5 units
18 - 19.9
6 units
Call MD if glucose less than 4 mmol/L or
greater than or equal to 20 mmol/L.
Blood Glucose
(mmol/L)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Other (see below)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
SIGNATURE
AND DESIGNATION ___________________________________________
TRANSCRIBED: PRINTED
NAME _______________________________________________________
FAXED DATE:
GENERIC EQUIVALENT AUTHORIZED
01/16
AMI CARE MAP
REVIEWER:
TIME:
INITIALS:
Authored by WRHA
ACS Diabetes Working Group
Blood Glucose (mmol/L)
Dose/Units Rapid Acting Insulin (Example: lispro, aspart) Subcut
10 - 11.9
2 units
12 - 13.9
3 units
14 - 15.9
4 units
16 - 17.9
5 units
18 - 19.9
6 units
Call MD if glucose less than 4 mmol/L or greater than or equal to 20 mmol/L.
Insulin Correction Dose Scale: Based on blood glucose monitoring (reassess individual need daily)
Note: Scale is used for treatment of pre-meal blood glucose
Diabetes Mellitus Type 2
*Continue oral medications and use Insulin Correction Dose Scale as required. Reassess in
48 hours for possible dosage adjustments to oral medications. If Insulin Correction Dose
Scale is required for more than 48 hours consider dose adjustments to oral medications.
Endocrine/Internal Medicine consult for patients with poor glycemic control: i.e. blood glucose constantly
greater than 12 mmol/L, new insulin starts, or marked changes in discharge insulin dosages.
**
Diabetes Mellitus Type 1
*Continue usual insulin regimen and supplement
with Insulin Correction Dose Scale as needed.
Blood glucose monitoring QID
If patient on oral diabetes medications:
• Consider adjusting dose(s) to maintain target pre-meal blood glucose 5 - 10 mmol/L.
• metFORMIN: Consider discontinuing till post hospital discharge, particularly if coronary angiogram candidates or patients with hepatic, renal or ventricular
dyusfunction. Note: metformin held procedure day and 48 hours post coronary angiogram/angioplasty.
• rosiglitazone or pioglitazone: Discontinue permanently.
Target: Pre-meal blood glucose 5 - 10 mmol/L (non-fasting)
Note: For patients who are critically ill and not eating, consider intravenous insulin infusion and appropriate glucose monitoring as required.
(ST Elevation AMI, Non-ST Elevation AMI)
Acute Myocardial Infarction Patients with Diabetes
WRHA Clinical Guideline