Insulin SafetyAmanda White
Eastern Gateway Community College
The purpose of this paper is to discuss safe administration of a high-alert medication, insulin. Discussed is why insulin is administered, the routes of administration, and a brief summary of diabetes mellitus. Vials and pens of insulin are compared, and it is explained why some hospitals choose to use insulin vials. Lastly, safe administration, including hospital policies, is discussed to better understand the safest way to administer insulin and decrease the number of insulin overdoses.
What is Insulin?
Insulin is a medication that is prescribed to individuals who have a diagnosis of type 1 diabetes mellitus or type 2 diabetes mellitus. “Diabetes mellitus is a chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both” (Lewis, Bucher, Heitkemper, Harding 2017, p.1120). Insulin is most commonly administered via a subcutaneous route though it may also be given intravenously, it is normally given multiple times a day, and more than one type of insulin may be used to control the high blood glucose levels. Insulin can either be fast acting, intermediate acting, or long acting which plays a big role in proper administration. “Authoritative guidelines and consensus statements from the Endocrine Society, American Association of Clinical Endocrinologists, American Diabetes Association, and American College of Endocrinology advise against the use of noninsulin therapy for most hospitalized patients with type 2 diabetes. Insulin is required for patients with type 1 diabetes.” (Lutz, Haines, Lesch, & Szumita 2016, p.17-18). Though insulin is used to help maintain high glucose levels in individuals with diabetes mellitus, it is not a cure for the disease.
Vial vs. Pen
Insulin can be in vials, meaning the individual has to physically draw the correct dosage up into an insulin syringe prior to administration. Insulin may also be in pens, to get the accurate dosage the individual just turns the dial to the correct number in units that they want to administer.” Insulin pens offer several advantages over vials, including ease of use, dosing accuracy, and decreased healthcare costs” (Gibbs et al., 2017, p.2054). Insulin pens are to be only used for one patient, therefore saying that one pen may not be used for multiple patients. If one pen is used between multiple patients there is an increased risk for transmission of infection and exposure to many blood-borne pathogens. Many hospitals transitioned back to using insulin vials due to the inappropriate practice of using 1 pen for multiple patients. There are many risks with using insulin vials example: many insulin overdoses which have even led to death. There is risk between the use of insulin pens and vials, but by following hospital policies these risks can be decreased.
According to the Institute for Safe Medication Practices, insulin is a high-alert medication. “Medication errors involving insulin are frequent, can occur at any stage of the medication-use process, and have the potential to cause serious harm” (Haines, Miklich, Rochester-Eyeguokan 2016, p.5). To try and reduce the number of insulin related medication errors most hospitals have a policy stating that “nursing staff members scan the insulin vial, draw up the dose in an insulin syringe, have a second nurse check the dose, and scan the patient’s barcode prior to administration” (Trimble, Bishop, Rampe 2017, p.72). In order for this policy to help reduce the number of insulin related medication errors, both nursing staff members involved in the process need to adhere to the policy and be on high alert for a potential error. Even the type of syringe used can be missed by the second person double checking the medication which can lead to a medication error and possible significant harm to the patient. Another important factor with safe administration of insulin is regarding how fast the insulin acts on the body. With fast acting insulin it is very important to have the patient eat within no more than 15 minutes of administration, it is even safer to have the patient already set up to eat directly after administration. “Ensure that insulin use is linked directly to patients’ nutrition status. Meal delivery, point-of-care glucose testing, and insulin administration should be well coordinated and standardized” (Cobaugh et al., 2013, p.1408). Education is also an important factor to patients and families. When educating patients and families it is important to explain how fast the insulin works, proper administration, diet and exercise. Many medical staff members are involved in teaching for insulin administration. Insulin is such a high-alert medication, following hospital policies and patient education are important factors for proper use of the medication.
In conclusion, insulin administration in hospitals remains as high risk as the medication itself. Following proper hospital policies will help with proper administration regarding technique and making sure that correct doses are given. As long as all staff members continue to follow proper policies the rate of insulin overdoses will hopefully go down. Maintaining patient safety and the rights of medication administration are key.
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Gibbs, H. G., Mclernon, T., Call, R., Outten, K., Efird, L., Doyle, P. A., . . . Zink, E. K. (2017). Randomized controlled evaluation of an insulin pen storage policy. American Journal of Health-System Pharmacy,74(24), 2054-2059. doi:10.2146/ajhp160348
Haines, S. T., Miklich, M. A., & Rochester-Eyeguokan, C. (2016). Best practices for safe use of insulin pen devices in hospitals: Recommendations from an expert panel Delphi consensus process. American Journal of Health-System Pharmacy,73(19_Supplement_5). doi:10.2146/ajhp160416
Lewis, S. M., Bucher, L., Heitkemper, M. M., & Harding, M. M. (2017). Medical-surgical nursing: Assessment and management of clinical problems. St. Louis, MO: Elsevier
Lutz, M. F., Haines, S. T., Lesch, C. A., & Szumita, P. M. (2016). Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program. American Journal of Health-System Pharmacy,73(19_Supplement_5). doi:10.2146/ajhp160417
Trimble, A. N., Bishop, B., & Rampe, N. (2017). Medication errors associated with transition from insulin pens to insulin vials. American Journal of Health-System Pharmacy,74(2), 70-75. doi:10.2146/ajhp150726