Medication errors associated with transition from insulin pens to insulin vials

Trimble, Adam N.; Bishop, Bryan M.; Rampe, Nancy

doi:10.2146/ajhp150726

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…While most hospitals use insulin pens, some institutions may use multi-dose insulin vials or a combination of both modalities. There are reports in the literature on medication errors associated with transitioning from one delivery system to another [11], and it is possible that the replacement nurses could have been unfamiliar with the preferred insulin delivery method at our institution. Instructions regarding the use of specific insulin pens were not included in the initial onboarding of the replacement nurses.…”

Section: Discussionmentioning

confidence: 99%

The Impact of a Nursing Strike on Glycemic Control in Hospitalized Patients with Diabetes

Sheahan

Kennedy²,

Tompkins³

et al. 2021

Cureus

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IntroductionHyperglycemia and hypoglycemia have been found to increase morbidity and mortality among hospitalized patients with diabetes. In July of 2018, our academic medical center experienced a 48-hour nursing strike, during which time 600 replacement nurses were employed. This cohort study evaluated the impact of the nursing strike on glycemic control among hospitalized patients with diabetes. MethodsPoint-of-care fingerstick blood glucose (POC BG) values among hospitalized patients with diabetes were compared between the 48-hour nursing strike period and two 48-hour periods when the nursing strike did not occur. We evaluated the percentage of POC BG values that were hyperglycemic (POC BG 181-250 mg/dL), severely hyperglycemic (POC BG >250 mg/dL), and hypoglycemic (POC BG <70 mg/dL). Additionally, we assessed the proportion of patients who experienced one or more days of hypoglycemia, hyperglycemia, or severe hyperglycemia. ResultsWe found a significant association between the distributions of POC BG test results during the nursing strike; test results more frequently showed hyperglycemia, severe hyperglycemia, or hypoglycemia during the nursing strike than during the control period (p=0.006). There was a significant difference in the days of hypoglycemia, with 7.7% of patients experiencing one or more days of hypoglycemia during the strike period compared with 1.4% of patients during the control period (p=0.03). ConclusionNursing strikes have been employed as a last resort in contract negotiations with hospitals, but they have the potential to significantly affect patient care and safety. Further studies are needed to evaluate these impacts to prepare for future workforce disruptions.

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Section: Discussionmentioning

confidence: 99%

The Impact of a Nursing Strike on Glycemic Control in Hospitalized Patients with Diabetes

Sheahan

Kennedy²,

Tompkins³

et al. 2021

Cureus

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“…A nurse may mistake the quantity being drawn up, or miscalculate the conversion in the use of concentrated insulin (eg, U-500 vial), leading to potentially catastrophic consequences. 28,29 Insulin pens simplify and improve dosing accuracy, as the number of units is plainly displayed on the pen. Overall, the use of insulin pens has resulted in greater satisfaction among nurses, physicians, and patients.…”

Section: Discussionmentioning

confidence: 99%

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

Najmi¹,

Haque

Ansari

et al. 2021

J Diabetes Sci Technol

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Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

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“…National, and international safety alerts [11][12][13][14][15] and studies [5,[16][17][18][19][20][21] have highlighted the levels of harm that have been caused to patients from the inappropriate prescribing and administration of insulin. A multitude of errors have been reported, ranging from prescribing errors due to mis-selection from dropdown lists or wrong drug being prescribed, to administration errors due to challenges of measuring doses using syringes instead of ready to use injection devices [5,9,17,19]. Given the harm that can be caused by the inappropriate prescribing and administration of insulin, insulin is included as one of five medication related never events within the National Health Service (NHS) Improvement's Never Event list [22].…”

Section: Introductionmentioning

confidence: 99%

“…These include the use of insulin syringes, education and training, and promoting self-administration of insulin within the hospital setting. [17,21,23]. Electronic prescribing systems are considered an important strategy in reducing medication errors including those involving insulin [10,24,25].…”

Section: Introductionmentioning

confidence: 99%

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Setra

Jani

2021

Pharmacy

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Accurate and complete prescriptions of insulin are crucial to prevent medication errors from occurring. Two core components for safe insulin prescriptions are the word ‘units’ being written in full for the dose, and clear documentation of the insulin device alongside the name. A retrospective review of annual audit data was conducted for insulin prescriptions to assess the impact of changes to the prescribing system within a secondary care setting, at five time points over a period of 7 years (2014 to 2020). The review points were based on when changes were made, from standardized paper charts with a dedicated section for insulin prescribing, to a standalone hospital wide electronic prescribing and medicines administration (ePMA) system, and finally an integrated electronic health record system (EHRS). The measured outcomes were compliance with recommended standards for documentation of ‘units’ in full, and inclusion of the insulin device as part of the prescription. Overall, an improvement was seen in both outcomes of interest. Device documentation improved incrementally with each system change—34% for paper charts, 23%–56% for standalone ePMA, and 100% for ePMA integrated within EHRS. Findings highlight that differences in ePMA systems may have varying impact on safe prescribing practices.

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Medication errors associated with transition from insulin pens to insulin vials

Cited by 7 publications

References 14 publications

The Impact of a Nursing Strike on Glycemic Control in Hospitalized Patients with Diabetes

The Impact of a Nursing Strike on Glycemic Control in Hospitalized Patients with Diabetes

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

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