2005 Edition Report on Drug Administration Procedure & Practices ...

Sensitivity:Prescription/ routewith Doctors’ signature & codeInsulin Administration /Test strip glucoseMonitoring FormHosp # ______________ ID # _____________________Name __________________________________________Sex _____ Age ____ CName ______________________(For Doctors / Nurses Use)Ward____ Bed ____ Dept ______________________H’stix glucose DatePage #monitoring Freq.Date Time Urine H’stix Treatment Given Check Given Remarksketone-ed by byOnOffOnOffOnOffOnOffDate Time Prescription/ route Dr. CheckedbyStat Dose Prescription (Please record under “Remarks”)Givenby.Date Time Prescription/ route Dr. CheckedbyGivenby• PRN insulin should be given before meal • Avoid frequent use of sliding scale which can lead to fluctuating blood glucose control• Capillary blood glucose should be done before or 2-hour post meal or when patient is symptomaticHAHO Apr 021