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Insulin Safety: Better Patient Care for Diabetes Patients

What are we looking to improve?
Beth Israel has identified insulin as a “high-alert medication,” meaning it has a heightened risk of causing significant harm due to its narrow therapeutic range. Errors in dosing and administration can negatively affect patient safety. An excessive dose, for example, can quickly cause hypoglycemia, which in turn can lead to seizure, coma and even death; too little of a dose can worsen hyperglycemia, which may progress to ketoacidosis. Approximately 35% of Beth Israel patients receive insulin. (The most common formulations are rapid-acting insulin and long-acting or basal insulin.) Through our initiative, we want to improve safety and satisfaction for all patients requiring glucose management.

What strategies/measures have we implemented for improvement?
We reviewed all components of our insulin medication management process, including ordering, dispensing, and administration and monitoring. Then, in March 2005, we replaced insulin vials with insulin pens, and also implemented tall-man lettering and patient-specific labels with expiration dates. Our nursing and pharmacy staffs received extensive education and training sessions on the new devices.

Additionally, we created hyperglycemia protocols based on basal/bolus insulin therapy, which uses different insulins together to treat diabetes.

What have we accomplished to date?
Since the inception of this initiative, Beth Israel endocrinologists have noted enhanced insulin delivery and overall improvement in glucose control, patient safety and patient satisfaction.

What are our future plans?
Beth Israel’s future plans for insulin safety include:

  • Reducing insulin syringes floor stock to ensure the use of pen needles
  • Having nursing conduct room inspections, where all pens are checked for expiration
  • Issuing pharmacy-only dispensing devices only upon request, not for each dose change
  • Training new nurses in using devices and needles
  • Adding the Lantus Solostar (insulin glargine) pen and Levemir (insulin detemir) pen to the formulary, and removing the Lantus (insulin glargine ) vial

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