Exploring risk and ease of use for insulin delivery by nurses

Analysis of factors affecting the accuracy of low-dose insulin dosage using syringes and vials: a cross-sectional study in a Japanese regional hospital

While several studies have shown that insulin pens are more convenient and accurate than conventional administration with syringes and vials (syringes/vials), there is a frequent need for low-dose insulin injections administered by nurses using syringes/vials in hospital settings, particularly for critically ill patients. However, there is a lack of research investigating factors related to the accuracy of low-dose insulin administration using syringes/vials, particularly in hospital settings. We therefore performed a cross-sectional study to assess the accuracy of low-dose insulin administration by registered nurses using syringes/vials and to determine whether time of day, years of experience and adherence to proper injection procedures (vertical insertion/drawing and air bubble checking) affected the accuracy. The participants were 33 registered nurses working in the diabetes ward, and a total of 198 trials were analyzed. Using syringes/vials, the median errors converted to insulin units were found to be 0.6 units for the 2- and 6-unit target doses, and 0.7 units for the 10-unit target dose. In cases with the largest error, errors for the 2-, 6-, and 10-unit target doses were observed to be 2.3, 4.0, and 3.3 units, respectively. In our study, time of day, years of experience and vertical insertion/drawing did not correlate with errors, but errors were significant in the participants who did not check for air bubbles. Nurses can make non-negligible dosage errors when administering low-dose insulin using syringes/vials, and this is particularly likely when air bubble checks are missed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00726-5.

Time-Motion Analysis of Nurses Utilizing Insulin Pen Devices Compared to Vial and Syringe in an Inpatient Setting

OBJECTIVE

To compare the time taken and steps completed by nurses in the process of insulin preparation and administration using the pen device compared to the vial and syringe method.

METHODS

Observational and exploratory study utilizing a time-motion analysis of nurses' administration of insulin using the pen versus vial and syringe delivery methods. Nurses were observed, video-recorded, and timed during insulin preparation and administration using each delivery method. The steps performed by nurses were observed against recommended processes for preparing and administering insulin, and the percentage of nurses completing each step was noted.

RESULTS

A total of 137 (94%) nurses participated. Nurses took less time preparing and administering insulin with the pen device compared with the vial and syringe method (79 ± 18 seconds vs 88 ± 20 seconds, respectively, P < .001). The overall average completion rate of steps with the pen device was 90% ± 7% compared to 88% ± 7% with the vial and syringe method.

CONCLUSION

The time taken by nurses to prepare and administer insulin was lower with the pen device compared with vial and syringe. Furthermore, areas were identified for potential nursing education to enhance safe and appropriate use of insulin with both delivery methods.

Nurses' perceptions and satisfaction with the use of insulin pen devices compared with insulin vial and syringes in an inpatient setting

BACKGROUND

The purpose of this study was to compare nurses' perceptions and satisfaction with the use of insulin pen devices versus vial and syringes for insulin delivery in an inpatient setting.

MATERIALS AND METHODS

The study used a descriptive design using self-report surveys. Nurses rated their perceptions on a 4-point Likert scale (from 1=strongly disagree to 4=strongly agree) on the ease of use, ease to teach patients, confidence and comfort in use, perceived time efficiency, safety of use, risk of needle sticks, and overall satisfaction and preference with use of each insulin delivery device.

RESULTS

In total, 139 (95%) nurses from nine nursing units at one hospital participated in this study. Compared with vial and syringe, nurses felt insulin pens were easier to use to measure insulin dose (mean±SD, 3.7±0.5 vs. 3.1±0.7; P<0.001), were easier to teach patients to use (3.5±0.6 vs. 2.8±0.7; P<0.001), provided more confidence in measuring insulin dose (3.7±0.5 vs. 3.4±0.6, P<0.001), saved on administration and preparation time (3.6±0.5 vs. 2.3±0.8; P<0.001), reduced the risk of giving a wrong dose of insulin (3.2±0.8 vs. 2.2±0.7; P<0.001), and reduced the risk of needle sticks (3.5±0.7 vs. 2.1±0.8; P<0.001). Overall, a majority of nurses preferred the use of insulin pens to vial and syringes in an inpatient setting (83% vs. 15%; P<0.05).

CONCLUSIONS

Nurses felt more comfortable and confident with the use of insulin pens compared with vial and syringes and perceived insulin pens to be a safer alternative for both patients and themselves.