Safety Issues: Use of Continuous Subcutaneous Insulin Infusion (CSM) Pumps in Hospitalized Patients

— The use of continuous subcutaneous insulin infusion (CSII) pump therapy is increasing. Patients on CSII at admission whose current admission diagnosis is not expected to affect their blood sugar, who are competent to manage their pumps, and who are in good control of their diabetes at the time of hospital admission may benefit from the good control of continued use of CSII during their stay. However, as with any insulin therapy, CSII can be dangerous if not managed appropriately.

Hospitals should be prepared to safely manage these patients by having protocols in place to carefully select those suitable to continue their pumps and to discontinue CSII when criteria are no longer met. All caregivers of the patient, including physicians, nurses, pharmacists, operating room and emergency staffs, and radiology technicians, must have an appropriate level of education on CSII. Hospitals not prepared to manage these patients may need to consider disconnection of the pump at admission.

There are few publications addressing management of CSII in the hospital setting. We review published reports and describe our approach to the management of CSII during hospitalization that includes: a case analysis of our experiences; the development of a policy and procedure, standardized physician order form, standardized pharmacy order entry, and educational programs for medical, nursing, radiology, and pharmacy staff; and physician credentialing.