07/08/2026
Change to VRIII guidance on Epic
We need to make you aware that there is a difference on Epic between the VRIII guidance and previous UHP guidelines.
In line with the One Devon system and in line with JBDS guidance, the order set includes the following changes:
• IV insulin rates have changed to the rates that are available on EPIC within the order set. There are still standard ,reduced, increased and custom doses.
** Please follow these guidelines **
• This is in line with the JBDs, any incidents that arise from the new rates should be datixed as per usual trust protocol.
• The order set for VRIII that includes both the insulin infusion and the maintenance fluids NO LONGER includes NaCl +/- K for glucose levels over 14mmol/L. Instead Clinicians should use their own clinical judgement to determine if additional hydration or electrolyte support is required at that stage.
• The rate of fluids to go along with the insulin infusion is set at 80ml/h. This is unless there is clinical reasons for it to be changed eg renal impairment, heart failure etc. Which can then be changed by the medical teams looking after the patient using clinical judgement.
• Although no longer stated on the order set please ensure that all Oral Hypoglycaemic Agents and injectables ( GLP1/ GLPI/GIP) are HELD while patients are on a VRIII.
• For nursing teams please ensure that any rate changes are documented on the MAR chart under Rate Change, this will then automatically be updated into the intake columns under insulin on the I/O chart. This information will also been added to an insulin chart under the CBG and ketone charts over the next week weeks.
• For those who have used the blue paper VRIII protocol over the last few days please ensure that this is scanned into media and uploaded onto Epic. We are aware that this has been used initially but as we get more used to the system these need to be discontinued to prevent confusion in the rate changes.
Please be aware that the form on health toolbox will be updated as soon as able, in the meantime if any issues arise please contact the diabetes team for further support.
