RN Train-the-Trainer Course: Delegation Considerations - 4

Delegation Considerations (continued)

1. South Dakota Specific Delegation Considerations
2. Delegation Decision-Making
3. South Dakota Administrative Rules Relating to Delegation
4. Delegating Insulin Dose Determination
5. Delegation Case Scenarios

4. Delegating Insulin Dose Determination

The registered nurse may choose to delegate the task of insulin administration. To safely delegate this task the RN is responsible to work with the UDA to determine the correct insulin dose. The physician's order, or the Diabetes Medical Management Plan (DMMP), provides information on determining the correct dose. Insulin may be ordered in several different ways:

• Fixed Dose: The person with diabetes will get the same amount of insulin at the same time every day.
• Sliding Scale: The insulin dose administered will be based on the blood glucose result taken immediately prior to the insulin being given.
• Insulin-to-Carbohydrate Ratio and Correction Factor: The amount of meal insulin given is based on the amount of carbohydrate the person with diabetes plans to consume (or has consumed) and the pre meal glucose.

The RN is responsible for using and helping the UDA to use the Insulin to Carb Ratio Dose - Worksheet any time the person with diabetes needs to receive a meal insulin dose ordered by the physician using this method.

Refer to the Approved Training for UDAs for additional information on each of these insulin dosing methods. The registered nurse needs to be completely comfortable with each method of insulin dose determination before delegating to the UDA.

See the SD Board of Nursing's Insulin to Carb Ratio Dose - Worksheet for RN Delegation of Insulin, printed on page 16.

Insulin to Carb Ratio Dose - Worksheet

An example of how to use this worksheet is located in the UDA Training Module: 5. Insulin Basics.

Rounding Numbers

When the dose is not a whole number you need to round to a half number or a whole number depending on the type of insulin syringe or insulin pen the patient or student uses. Follow these guidelines:

1. Do not round until you have calculated the TOTAL insulin dose (both the "meal" and the "correction factor" doses).
2. If the person is administered whole unit doses of insulin, round to the nearest whole number.
3. If the person gets half unit doses, round to the nearest half number.