Insulin prescribing and administration errors in hospital cause significant risk. The paediatric diabetes team worked together with the pharmacist and paediatric unit staff to design and produce an insulin prescription drug ‘insert’ for in-patients that can be attached to each individual’s existing drug chart. The aim of this was to aid the prescription and administration of insulin injections, ensuring they are given correctly and safely, thereby reducing insulin drug errors and improving patient safety. There has been a 50 per cent reduction in errors with the administration of the insulin, including no missed doses due to unprimed pens and no over corrections.
Insulin prescribing and administration errors in hospital create a significant risk. Insulin safety has been a hot topic for some time and insulin safety training is now mandatory across the NHS. The health service offers regular education to both junior doctors and nursing staff on the safe use of insulin and diabetes management and carbohydrate counting but this knowledge can be difficult to put into practice.
Busy shifts, higher risk patient groups, limited experience and a drug chart that is poorly designed for insulin prescriptions are all contributory risk factors. For example, different elements of the insulin prescription can appear on different pages of the drug administration chart and there may be no easy way of prescribing a variable dose.
At Imperial College Healthcare NHS Trust, staff support patients with carbohydrate counting because increasing the dosage of insulin to correct high blood glucose levels increases room for error.
The Trust has a low admission rate for paediatric diabetes patients so ward staff are relatively inexperienced, which again increases the risk of mistakes.
With the ambition of maximising patient safety by reducing insulin administration errors, the objective was to encourage good practice among all ward staff in the management of insulin injections from dose decision, insulin type and timing, through to administration technique and accuracy.
This was to be achieved by designing a prescription insert page that would guide good practice. The project needed to involve the whole team in design and implementation, to adapt existing prescribing systems to make implementation as easy as possible and to inspire a trusting relationship between staff and patients.
All common insulin drug errors were reviewed, including priming insulin pens and ensuring that they worked. It also considered the over-correction of high Bg levels because different parts of the drug chart were used for different insulin doses.
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