Skip to main content

Notice of update: Insulin Dose Adjustment DST and Competency Framework for Registered Nurses

Sep 8, 2021

BCCNM is informing registered nurses of updates to the Insulin Dose Adjustment Decisio​n Support Too​l and Competency Framework for Registered Nurses, referenced in the RN Scope of Practice relating to RNs when adjusting insulin dosages. The DST ​includes a description of limits and conditions for Insulin Dose Adjustment (IDA), required clinical competencies, and intended/unintended outc​omes of IDA. The revisions were informed by key informants and audiences across the health authorities.

What are the revisions or additions?​​​

  1. New title of the document—includes competency framework.
  2. New definition for "insulin dose adjustment". Note that changing the type of insulin is out of scope for RNs.
  3. With above revision, removed the unintended outcome of “potential allergic reaction associated with change in insulin type".
  4. Added clarity to when a prescriber order is required.
  5. Addition to “Physician or NP Consultation Required"—for clients  on steroids or medications that can significantly impact blood glucose readings.​
  6. Continuous (sensor) glucose (CGM) and flash glucose monitoring is a new basic competency added.
  7. Basal Bolus with multiple daily injections (MDI) is now a basic competency (no longer an advanced competency) and includes additional competencies.
  8. Basal Bolus with continuous subcutaneous insulin infusion (CSII) also includes additional advanced competencies.
  9. Revised reading list.
  10. Updated references.