Changes to medication-use processes after overdose of U-500 regular insulin

Monroe, Paul; Heck, Wendy; Lavsa, Stacey M.

doi:10.2146/ajhp110628

Cited by 13 publications

(10 citation statements)

References 7 publications

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“…In this section, we further develop the results and provide theoretical interpretations. Double checking in its different forms is seen as a trusted practice , and has been shown to be helpful in a number of studies and ISMP advisories in spite of the lack of supporting evidence . Some advisories allude to double checking being misunderstood and/or overrated .…”

Section: Discussionmentioning

confidence: 99%

Double checking: a second look

Hewitt

Chreim

Forster

2015

Evaluation Clinical Practice

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Rationale, aims and objectivesDouble checking is a standard practice in many areas of health care, notwithstanding the lack of evidence supporting its efficacy. We ask in this study: ‘How do front line practitioners conceptualize double checking? What are the weaknesses of double checking? What alternate views of double checking could render it a more robust process?’MethodThis is part of a larger qualitative study based on 85 semi‐structured interviews of health care practitioners in general internal medicine and obstetrics and neonatology; thematic analysis of the transcribed interviews was undertaken. Inductive and deductive themes are reported.ResultsWeaknesses in the double checking process include inconsistent conceptualization of double checking, double (or more) checking as a costly and time‐consuming procedure, double checking trusted as an accepted and stand‐alone process, and double checking as preventing reporting of near misses. Alternate views of double checking that would render it a more robust process include recognizing that double checking requires training and a dedicated environment, Introducing automated double checking, and expanding double checking beyond error detection. These results are linked with the concepts of collective efficiency thoroughness trade off (ETTO), an in‐family approach, and resilience.Conclusion(s)Double checking deserves more questioning, as there are limitations to the process. Practitioners could view double checking through alternate lenses, and thus help strengthen this ubiquitous practice that is rarely challenged.

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Section: Discussionmentioning

confidence: 99%

Double checking: a second look

Hewitt

Chreim

Forster

2015

Evaluation Clinical Practice

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“…It is recommended that hospitals have institutional policies for use of U-500 insulin in the inpatient setting. 8,10,43-45 These policies should define where U-500R will be stored in the pharmacy and/or nursing unit. The policy should dictate whether the syringe is filled in the pharmacy or on the patient care unit, how U500R should be prescribed, and how it should be administered.…”

Section: Inpatient Use Of U-500rmentioning

confidence: 99%

“…Because hospital formulary policies for U-500R predominantly use tuberculin/volumetric syringes (milliliter markings) 44,45 and U-100 syringes are the most often used syringes in outpatient settings (apart from Veterans Administration facilities), instruction (or reinstruction) on the use of U-100 insulin syringes may be needed at discharge. Upon reviewing the conversion of actual units of U-500R to measured unit markings on a U-100 syringe, the diabetes educator can also ensure that take-home instructions and prescriptions include actual units of U-500R in addition to the U-100 syringe unit markings.…”

Section: Inpatient Use Of U-500rmentioning

confidence: 99%

Practice Tips and Tools for the Successful Use of U-500 Regular Human Insulin

Cochran

Valentine²,

Samaan

et al. 2013

Diabetes Educ

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This review provides information to equip diabetes educators to instruct and guide patients in using U-500 human regular insulin (U-500R). The article includes an overview of U-500R pharmacology and clinical data, strategies for outpatient and inpatient use, and tools for patient education. U-500R is useful for treating patients with any type of diabetes who require high doses of insulin. U-500R alleviates the volume-related problems associated with high doses of U-100 insulin, making treatment with high doses of insulin more feasible (because of the need for fewer injections for patients) as well as more cost-efficient and potentially more effective. These tools can help diabetes educators feel more comfortable and confident as they advise and educate patients who receive high-dose U-500R as part of their overall diabetes care plan. The diabetes educator plays a vital role in helping patients use U-500R safely and successfully.

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“…These included storage of U‐500 insulin vials in pharmacy only, restricting prescribing to the endocrine service, developing a specific order set for U‐500 insulin, preparing U‐500 insulin in pharmacy as patient specific doses, using tuberculin syringes for U‐500 insulin, double checking of the dose by two pharmacists at the time of dispensing and by two registered nurses at the time of administration. New patient education materials were also produced . Where intravenous insulin infusion is required patients must be switched back to U‐100 insulin, but may require high infusion rates at higher blood glucose levels .…”

Section: Guidelines For Usementioning

confidence: 99%

The use of U‐500 regular insulin in the management of patients with obesity and insulin resistance

Jones

Idris

2013

Diabetes Obesity Metabolism

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The rise in prevalence of obesity and diabetes has created a challenge in managing increasing numbers of patients who require high doses of insulin. This article reviews the published literature on the properties of U-500 insulin and its use in clinical practice. U-500 insulin is likely to have a longer time to peak effect and a longer duration of action than similar doses of U-100 insulin. Evidence for its use in clinical practice rests on retrospective case series, which suggests that the use of U-500 insulin either by multiple daily injections or a continuous subcutaneous insulin infusion is effective in improving glycaemic control. To prevent insulin dosing and administration errors, great care must be taken in providing staff and patient education, and in developing policies for the management of patients on U-500 insulin who are admitted to hospital.

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Changes to medication-use processes after overdose of U-500 regular insulin

Abstract: A multidisciplinary team recommended modifications to the medication-use system regarding U-500 regular insulin after review of a medication error. No errors involving U-500 regular insulin have been reported since implementation of the changes.

Cited by 13 publications

References 7 publications

Double checking: a second look

Double checking: a second look

Practice Tips and Tools for the Successful Use of U-500 Regular Human Insulin

The use of U‐500 regular insulin in the management of patients with obesity and insulin resistance

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