In-Hospital Administration of Insulin by Nurses in Northern Greece: An Observational Study

Abstract

Objective.The purpose of this study is to explore current practice regarding insulin administration by nurses in a Greek public hospital.Design and methods.A mixed-methods qualitative data collection design was used with ad hoc nonparticipant observation and post hoc interviews with the staff involved. Insulin management and administration was observed and compared to international guidelines. A sample of 20 nurses from two medical wards was assessed on 100 occasions of insulin administration, and 8 nurses were subsequently interviewed.Results.Inter-rater agreement was found to be satisfactory (average κ 0.840). In 61% of all instances, nurses washed their hands before administering insulin, and, in 70%, they donned gloves before injections. In 64.5% of all instances, the nurses did not clean the insulin bottle before inserting the needle, and in 42.7% of instances, they did not check for air bubbles in the syringe. In 89.1% of instances, nurses did not check the injection site for appropriateness or other possible complications. However, in 90.9%, they cleaned the skin at the injection site with an alcohol swab. In 70.9% of all instances, the needle was placed vertically to the skin but without a skinfold. In 89.1% of instances, post-injection care was rated as poor.Conclusion.Overall, compliance with international guidelines regarding insulin administration techniques, as observed in these sample wards, is not satisfactory. Nurses in this Greek hospital tend to administer subcutaneous injections in ways not reflected in current research findings, practice guidelines, or evidence-based care recommendations. Evidently, Greek nurses in this sample require updating on current evidence-based practice, clinical guidelines, and protocols of care regarding routine insulin administration.

Assessment of Insulin Injection Practice of Nurses Working in a Tertiary Healthcare Center of Nepal

“…This results in younger and less experienced nurses in the healthcare system of Nepal. Similar cases of insufficient knowledge of practicing nurses on insulin administration were observed in Northern Ireland [ 9 ], Pakistan [ 11 ], Greece [ 12 ], and United States [ 30 ]. Other studies in Jordan [ 10 ] and United States [ 31 ] also reported that nurses had inadequate knowledge on insulin.…”

“…Similarly, study in Jordan showed that registered nurses had insufficient knowledge on insulin storage and preparation [ 10 ]. Likewise, studies from Pakistan [ 11 ] and Greece [ 12 ] also demonstrated that nurses have inadequate knowledge on insulin injection technique. Such inadequacies may cause insulin administration errors and adverse outcomes.…”

Insulin Injection Knowledge, Attitudes, and Practices of Nurses in China: A Cross-Sectional Nationwide Study

“…Nurses in training, interns, and nursing students were excluded. Nurses were randomly chosen from 231 grassroot hospitals, 453 secondary care hospitals, and 564 tertiary care hospitals listed on the Chinese government’s official website [ 11 ]. Data on gender, age, years worked, professional title, and administrative title were retrieved.…”

Forum for injection technique and therapy expert recommendations, India: The Indian recommendations for best practice in insulin injection technique, 2017

“…[ 94 ] In recent years, case reports on LA have increased in the scientific literature indicating that LA may also develop after treatment with recombinant human insulins or insulin analogs. [ 155 156 ]…”