Aim of assessment
The eleven components of the valid routine subcutaneous insulin medication order includes the purpose of the order, followed by the general instructions regarding the order. The next component is the identification and the demographics of the patient and the involved hospitals. This is followed by monitoring of the blood glucose level frequency and the notification to the medical officer in such cases. The next component is the monitoring record of the blood glucose levels. This is followed by insulin orders and the documentation of the insulin administration. The next component of the order is the comment section which is followed by guidelines for managing hyperglycaemia alerts. The next component is the hypoglycaemia management in diabetes for the adults and finally there is a pharmacy review (Wong et al., 2016).
This is important as the supplemental insulin orders have been aligned with the BGL monitoring area of the new order. Additionally the routine insulin is seen to be aligned with the daily BGL monitoring and insulin administration areas.
NovoRapid insulin is prescribed to patients with type 1 diabetes since it includes all the active ingredients of insulin. Individuals with diabetes lack or have a deficiency of the hormone insulin which is secreted by the pancreas. Insulin is the main hormone that responsible for the controlling of sugar level in the blood. Therefore people with diabetes have to be injected with insulin externally to control their glucose level in the blood. NovoRapid is a fast acting insulin that is injected under the skin to lower the blood glucose level. This takes about 10 to 20 minutes to work (Bowering et al., 2017).
According to Bullock and Manias (2017) the onset is 10 to 30 minutes, the peak is for 30 minutes to 3 hours and the duration is for 3 to 5 hours. The NovoRapid insulin should be administered immediately prior to having food because of the rapid onset of action. This be before the start of the meal and should not exceed more than 5-10 minutes after injection. However sometimes if necessary it can be soon after the meal, instead of before the meal (Bullock& Manias, 2013).
Hypoglycaemia is referred to the condition which occurs when the blood glucose level falls below a set point that might be 4 mmol/L. The symptoms include sweating along with fatigue and dizziness. Other symptoms might include feeling hungry, blurred vision and sometimes in extreme case it might lead to coma. The causes of the disease include high dosage of medication like insulin along with delayed meals. Often exercise and alcohol also might cause the disease. Treatment involves eating along with drinking a amount of 15-20g of carbohydrate which is fast acting such as glucose tablets or sweets, sugary fizzy drinks or fruit juice (Frier, 2014).
Case study
It is important to understand the medication before administration in order to ensure that there is no medication error. This is because medication errors are the most significant errors in health care, which challenges the patient safety. Administration of medication requires good decision making skills. In order to do so understanding the medication is required so that a clinical judgement can be made (Keers, Williams, Cooke& Ashcroft, 2013).
The five rights of medication administration involves the right patient, the right drug, the right route followed by right dose and the right time. This is important to be followed by the nurses as this helps to reduce medication errors that takes place during the administration of a medication. If the five rights are maintained as goals in the process of medication then medication safety will be ensured (Dolansky, Druschel, Helba& Courtney, 2013).
For the patient Ben, the appropriate needle size for insulin injection would be 4mm (Hirsch, Byron&Gibney, 2014).
Before administration of NovoRapid the following nursing assessments are needed to be conducted. This includes the consideration that whether the patient’s insulin is available in the vials or the prefilled devices. The dose required for the patient is needed to be checked from the patient’s prescription chart. Before the administration the expiry date needs to be checked. Before administration the blood glucose level needs to be checked. The injection site also needs to be determined (Frid et al., 2016) .
This Novarapid is generally injected under the skin and at a 90 degree angle in order to get the best penetration. The site is slightly pinched before applying the injection and the plunger is pressed until the dial goes back to 0.For prevention of infection during insulin administration, the following steps might be taken: avoiding Fingerstick devices to be applied to more than one patient. The blood glucose meters should not be shared with others. The insulin pens along with medication cartridges and the syringes should be used only for single-patient-use and not for more than one person (Smith et al., 2017).
Documentation is required before and after administration in order to prevent medication error. The documentation provides records to the doses that the patient has been administered with (Nicolucci et al., 2013).
After the administration of the drug, the blood glucose level again needs to be monitored. The nurses will be responsible for the safe disposal of the syringe after the administration. The nurses will be responsible for recording the insulin taken along with your blood glucose levels (Young-Hyman et al., 2016).
Medical history
Living with diabetes type 1 has several challenges like lifestyle changes which involves diet modification along with blood glucose monitoring needed on a regular basis. There is a need for carbohydrate counting along with very regular administration. The challenges also include the implementation of self-management skills (Nicolucci et al., 2013).
Presence of diabetes increases stress and distress in patients especially in the younger adults. They undergo various emotional problems along with psychological changes, depression being the most prevalent among all the other symptoms. This leads to negative disease outcomes and poor functioning of the overall health functioning (Young-Hyman et al., 2016).
References
Bowering, K., Case, C., Harvey, J., Reeves, M., Sampson, M., Strzinek, R., … & Bode, B. W. (2017). Faster aspart versus insulin aspart as part of a basal-bolus regimen in inadequately controlled type 2 diabetes: the onset 2 trial. Diabetes Care, dc161770. Retrieved from: https://doi.org/10.2337/dc16-1770
Bullock, S., & Manias, E. (2013). Fundamentals of pharmacology. Pearson Higher Education AU. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=ODjiBAAAQBAJ&oi=fnd&pg=PP1&dq=fundamentals+of+pharmacology+bullock&ots=WJcdK9Ei-Q&sig=8IIPCnnUJwv9Ph2Nq_OGXHrq1WE#v=onepage&q=fundamentals%20of%20pharmacology%20bullock&f=false
Dolansky, M. A., Druschel, K., Helba, M., & Courtney, K. (2013). Nursing student medication errors: a case study using root cause analysis. Journal of professional nursing, 29(2), 102-108. Retrieved from: https://doi.org/10.1016/j.profnurs.2012.12.010
Frid, A. H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L. J., … &Kalra, S. (2016, September). New insulin delivery recommendations. In Mayo Clinic Proceedings (Vol. 91, No. 9, pp. 1231-1255). Elsevier.Retrieved from:https://doi.org/10.1016/j.mayocp.2016.06.010
Frier, B. M. (2014). Hypoglycaemia in diabetes mellitus: epidemiology and clinical implications. Nature Reviews Endocrinology, 10(12), 711. Retrieved from: https://www.nature.com/articles/nrendo.2014.170
Hirsch, L., Byron, K., &Gibney, M. (2014). Intramuscular risk at insulin injection sites—measurement of the distance from skin to muscle and rationale for shorter-length needles for subcutaneous insulin therapy. Diabetes technology & therapeutics, 16(12), 867-873.Retrieved from:https://doi.org/10.1089/dia.2014.0111
Keers, R. N., Williams, S. D., Cooke, J., & Ashcroft, D. M. (2013). Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy, 47(2), 237-256. Retrieved from:https://doi.org/10.1345/aph.1R147
Nicolucci, A., Kovacs Burns, K., Holt, R. I., Comaschi, M., Hermanns, N., Ishii, H., … &Tarkun, I. (2013). Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national benchmarking of diabetes?related psychosocial outcomes for people with diabetes. Diabetic medicine, 30(7), 767-777.Retrieved from:https://doi.org/10.1111/dme.12245
Smith, M. G., Ferreri, S. P., Brown, P., Wines, K., Shea, C. M., &Pfeiffenberger, T. M. (2017). Implementing an integrated care management program in community pharmacies: a focus on medication management services. Journal of the American Pharmacists Association, 57(2), 229-235.Retrieved from:https://doi.org/10.1016/j.japh.2016.12.074
Wong, V. W., Ho, A., Fiakos, E., Lau, N. S., & Russell, H. (2016). Introduction of New South Wales adult subcutaneous insulin?prescribing chart in a tertiary hospital: its impact on inpatient glycaemic control. Internal medicine journal, 46(11), 1323-1328. Retrieved from: https://doi.org/10.1111/imj.13229
Young-Hyman, D., De Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., &Peyrot, M. (2016). Psychosocial care for people with diabetes: a position statement of the American Diabetes Association. Diabetes Care, 39(12), 2126-2140.Retrieved from: https://doi.org/10.2337/dc16-2053
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