Diabetes order sets

These diabetes order sets are based on content released into the public domain by Kaiser Permanente.

Each order set contains a variety of common orders for patients with diabetes. One of the major questions in order set design is whether a good order set has all of the choices someone might want (which implies that an order set is a tool for making ordering quicker), or whether it should contain the "best" choices (which implies that an order set is a tool for influencing ordering behavior). These two order sets lean towards the side of inclusiveness, although they do make a careful effort to be evidence-based, and generally contain drugs available in a generic form in the United States.

This flow sheet contains a set of lab results useful in the clinical management of a patient with diabetes. Many clinical information systems allow for the creation of flow sheets like this, so that specific subsets of lab results can be viewed by the user.

An order set for Type II Diabetes, with a focus on DM management

• Diagnoses (with ICD-9 codes)
  • • DM 2 [250.00H]
    • DM 2 W DIABETIC NEPHROPATHY
    • DM 2 W DIABETIC PERIPHERAL NEUROPATHY
• Medications
  • • SURESTEP TEST STRIPS (Sig: Use as directed for diabetes, Disp: 100)
    • ONE TOUCH ULTRASOFT LANCETS (Sig: Use as directed, Disp: 100)
    • ONE TOUCH ULTRA 2 KIT (Sig: Use as directed, Disp: 1)
    • ONE TOUCH ULTRA TEST STRIPS (Sig: Use as directed, Disp: 100)
    • ASPIRIN 81 MG ORAL EC TAB (Sig: TAKE 1 TAB PO ONCE DAILY FOR DIABETES HEART PROTECTION, Disp: 100)
    • ASPIRIN 325 MG ORAL EC TAB (Sig: TAKE 1 TAB PO ONCE DAILY FOR DIABETES HEART PROTECTION, Disp: 100)
    • METFORMIN 500 MG ORAL TAB (Sig: TAKE 1 TAB PO BID FOR DIABETES, Disp: 120)
    • METFORMIN 1,000 MG ORAL TAB (Sig: TAKE 1 TAB PO BID FOR DIABETES, Disp: 120)
    • GLIPIZIDE 5 MG ORAL TAB (Sig: TAKE 1 TAB PO ONE DAILY FOR DIABETES, Disp: 60)
    • GLIPIZIDE 5 MG ORAL TAB (Sig: TAKE 1 TAB PO BID FOR DIABETES, Disp: 120)
    • GLIPIZIDE 10 MG ORAL TAB (Sig: TAKE 1 TAB PO ONE DAILY FOR DIABETES, Disp: 60)
    • GLIPIZIDE 10 MG ORAL TAB (Sig: TAKE 1 TAB PO BID FOR DIABETES, Disp: 120)
    • GLIPIZIDE 10 MG ORAL TAB (Sig: TAKE 2 TABS PO BID FOR DIABETES, Disp: 240)
    • SIMVASTATIN 10 MG ORAL TAB (Sig: take 1 tab po once daily for cholesterol, Disp: 60)
    • SIMVASTATIN 20 MG ORAL TAB (Sig: take 1 tab po once daily for cholesterol, Disp: 60)
    • SIMVASTATIN 40 MG ORAL TAB (Sig: take 1 tab po once daily for cholesterol, Disp: 60)
    • SIMVASTATIN 80 MG ORAL TAB (Sig: take 1 tab po once daily for cholesterol, Disp: 60)
    • LISINOPRIL 10 MG ORAL TAB (Sig: TAKE 1 TAB PO ONCE DAILY FOR BLOOD PRESSURE AND KIDNEY PROTECTION, Disp: 60)
    • LISINOPRIL 20 MG ORAL TAB (Sig: TAKE 1 TAB PO ONCE DAILY FOR BLOOD PRESSURE AND KIDNEY PROTECTION, Disp: 60)
    • LISINOPRIL 40 MG ORAL TAB (Sig: TAKE 1 TAB PO ONCE DAILY FOR BLOOD PRESSURE AND KIDNEY PROTECTION, Disp: 60)
    • LISINOPRIL-HYDROCHLOROTHIAZIDE 10 MG-12.5 MG TAB (Sig: TAKE 1 TAB PO ONCE DAILY FOR BLOOD PRESSURE AND KIDNEY PROTECTION, Disp: 60)
    • LISINOPRIL-HYDROCHLOROTHIAZIDE 20 MG-12.5 MG TAB (Sig: TAKE 1 TAB PO ONCE DAILY FOR BLOOD PRESSURE AND KIDNEY PROTECTION, Disp: 60)
    • LISINOPRIL-HYDROCHLOROTHIAZIDE 20 MG-25 MG TAB (Sig: TAKE 1 TAB PO ONCE DAILY FOR BLOOD PRESSURE AND KIDNEY PROTECTION, Disp: 60)
    • NPH INSULIN 100 UNIT/ML INJ (Sig: INJECT SUBCUTANEOUSLY AS DIRECTED FOR DIABETES, Disp: 20)
    • REGULAR INSULIN 100 UNIT/ML INJ (Sig: INJECT SUBCUTANEOUSLY AS DIRECTED FOR DIABETES, Disp: 20)
• Immunizations (with CPT codes)
  • Immunization
    • TDaP Vaccination 0.5 ml IM (ages 11-64) [90715A]
    • Td (adult) vaccination, 0.5 mL IM (age 65 and over) [90718C]
    • Pneumococcal Polysaccharide (Pneumovax) vaccination, 0.5 mL IM [90732C]
    • Influenza vaccination, 3 yr - adult, 0.5 mL IM [90658C]
    • Influenza vaccination, 0.5 mL IntraNasal [90660C]
  • Administration Codes
    • VACC ADMIN, FIRST IM OR SUBQ VACCINE TOXOID (Always order) [90471B]
    • VACC ADMIN, EACH ADDITIONAL IM OR SUBQ VACCINE TOXOID (For 2 or more total IMM's select FIRST IMM code above, and this code for each additional administration) [90472B]
    • VACC ADMIN, FIRST INTRANASAL OR PO VACCINE TOXOID [90473B]
• Lab orders (with CPT codes)
  • Labs today
    • CBC W DIFFERENTIAL, AUTO [85025B]
    • POTASSIUM, SERUM [84132C]
    • CREATININE, SERUM [82565C]
    • GLUCOSE, FASTING [82947B]
    • ELECTROLYTES, SERUM [80051E]
    • TSH W REFLEX TO FT4 [84443K]
    • TSH ONLY [84443B]
    • LIPID PANEL, FASTING [80061B]
    • LIPID PANEL, NON-FASTING [80061D]
    • ALT, SERUM [84460B]
    • PSA [84153B]
    • HEMOGLOBIN A1C [83036B]
    • MICROALBUMIN/CREATININE, URINE [200479]
  • Labs today
    • CBC W DIFFERENTIAL, AUTO [85025B]
    • CREATININE, SERUM [82565C]
    • GLUCOSE, FASTING [82947B]
    • ELECTROLYTES, SERUM [80051E]
    • TSH W REFLEX TO FT4 [84443K]
    • TSH ONLY [84443B]
    • LIPID PANEL, FASTING [80061B]
    • LIPID PANEL, NON-FASTING [80061D]
    • ALT, SERUM [84460B]
    • PSA [84153B]
    • HEMOGLOBIN A1C [83036B]
    • MICROALBUMIN/CREATININE, URINE [200479]
  • Labs in 3-12 months
    • CBC W DIFFERENTIAL, AUTO [85025B]
    • CREATININE, SERUM [82565C]
    • GLUCOSE, FASTING [82947B]
    • ELECTROLYTES, SERUM [80051E]
    • TSH W REFLEX TO FT4 [84443K]
    • TSH ONLY [84443B]
    • LIPID PANEL, FASTING [80061B]
    • LIPID PANEL, NON-FASTING [80061D]
    • ALT, SERUM [84460B]
    • PSA [84153B]
    • HEMOGLOBIN A1C [83036B]
    • MICROALBUMIN/CREATININE, URINE [200479]
  • Standing Lab Orders
    • HEMOGLOBIN A1C (HGB A1C) q 3 months for 1 year [83036B]
• Procedures (with CPT codes)
  • • ANNUAL SCREENING, DM FOOT USING TOUCH PRESSURE QUANT. SENSORY TESTING, PER FOOT [0106TA]

Another order set for diabetes, with a focus on complications

• Diagnoses (with ICD-9 codes)
  • Diabetes related
    • SENSORY PROBLEM W FEET, HIGH RISK [V49.3H]
    • SENSORY PROBLEM W FEET, LOW RISK [V49.3I]
    • SCREENING, DIABETIC RETINOPATHY [V72.0T]
  • Screening for other conditions
    • SCREENING FOR CA, BREAST, BY MAMMOGRAM [V76.12G]
    • SCREENING FOR CA, CERVIX [V76.2A]
    • SCREENING FOR CA, COLON [V76.51A]
    • SCREENING EXAMINATION FOR CA, PROSTATE [V76.44A]
    • SCREENING, ENDOCRINE, NUTRITIONAL, OR METABOLIC [V77.99G]
    • SCREENING [V82.9B]

• Diabetes-related Orders (with CPT codes)
  • Lab today
    • HEMOGLOBIN A1C [83036B]
    • LIPID PANEL [80061]
    • LDL DIRECT [83721C]
    • MICROALBUMIN SCREEN URINE [213757]
    • ALT, SERUM [84460B]
    • AST, SERUM [84450B]
    • REF EYE CARE, DIABETIC SCREENING [217755]
  • Lab in 2-6 months
    • HEMOGLOBIN A1C [83036B]
    • LIPID PANEL [80061]
    • LDL DIRECT [83721C]
    • MICROALBUMIN SCREEN URINE [213757]
    • ALT, SERUM [84460B]
    • AST, SERUM [84450B]
  • Lab in 6-12 months
    • HEMOGLOBIN A1C [83036B]
    • LIPID PANEL [80061]
    • LDL DIRECT [83721C]
    • MICROALBUMIN SCREEN URINE [213757]
    • ALT, SERUM [84460B]
    • AST, SERUM [84450B]
• Other related orders
  • Lab today
    • CBC W DIFFERENTIAL, AUTO [85025B]
    • SODIUM, SERUM [84295A]
    • POTASSIUM BLOOD [84132A]
    • CHLORIDE, SERUM [82435C]
    • BUN, SERUM [84520M]
    • CREATININE, SERUM [82565C]
    • OCCULT BLOOD ST 3 SPECIMENS [82270A]
    • PAP, LIQUID BASE SCREEN [88174C]
    • PSA [84153B]
    • TSH W REFLEX TO FT4 - order if screening [84443K]
    • THYROID STIMULATING HORMONE (TSH ONLY)- order if monitoring [84443A]
    • URINALYSIS W REFLEX TO MICROSCOPY AND CULTURE [81003G]
• Referral, imaging and reminder orders
  • • FLEX SIG [214156]
    • REF COLON CANCER SCREENING HI RISK (aka COLONOSCOPY) [213973]
    • REMIND TO HAVE PAP EXAM [213594]
    • XR MAMMOGRAPHY SCREENING BILATERAL, 2 VIEWS EACH BREAST [77057K]