Review of Medication Error Sources Associated With Inpatient Subcutaneous Insulin: Recommendations for Safe and Cost-Effective Dispensing Practices

Background: The challenge of addressing variation in practice is underlined by variation in institutional operational and financial limitations, which ultimately directs institutional insulin dispensing strategy. Insulin therapy is multi-modal, and inpatient pharmacies may be responsible for simultaneously managing up to 8 formulations. While available as a tool for glycemic management in the inpatient setting, intravenous (IV) insulin and insulin pumps are out of scope for this review. Considerations when designing subcutaneous insulin dispensing processes include medication safety, infection control, pharmacy workflow, nursing workflow, drug cost, hardware cost, and hospital policy. Objective: This review provides an overview of common inpatient subcutaneous insulin dispensing practices, describes the regulations directing current practice, and discusses the benefits and risks of each dispensing practice. Finally, the review provides recommendations for subcutaneous insulin dispensing practices with respect to institutional limitations that minimize patient safety risk and consider the variable costs that practices incur. Methods: Common formulations will be presented along with medication safety considerations and potential medication administration errors to preface strategies for management. Conclusion: Nearing the centennial anniversary of the invention of insulin, the practice of dispensing subcutaneous insulin products has remained a core responsibility of the hospital pharmacy as a primary treatment option for Diabetes Mellitus. Despite the continued presence of this product as a universal component of the hospital formulary, subcutaneous insulin dispensing practices remain varied institution-to-institution.