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Hiscox A, Armbrust J, Shin M, Bahng J. Impact of Lowered Inpatient Correctional Bedtime Insulin Dosing on Glycemic Outcomes of Veterans. J Pharm Pract 2024; 37:1141-1148. [PMID: 38261799 DOI: 10.1177/08971900241228776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Purpose: This study evaluated glycemic outcomes for hospitalized patients after reduction in bedtime correctional insulin dosing. Methods: This was a retrospective, single-center analysis of a protocol change that reduced bedtime correctional insulin scale. Comparable cohorts pre- and post-protocol change were created which included patients who were ordered correctional insulin with at least 1 blood glucose (BG) reading. The primary outcome was number of nocturnal hypoglycemia readings. Secondary outcomes included, but were not limited to, mean fasting BG, BG within various ranges, and length of stay. Results: 3 percent of patients in the post-protocol change group (N = 100) experienced nocturnal hypoglycemia compared to 6% of patients in the pre-change group (N = 100) (P = .507). There were no significant differences in BG ranges <110 mg/dL, <140 mg/dL, 140 to 180 mg/dL, and >180 mg/dL. However, 19% of patients in the post-protocol change group had BG of >250 mg/dL as compared to 9% in the pre-change group (P = .033). Mean fasting BG was higher in the post-protocol change group compared to the pre-change group (156.5 mg/dL vs 139.3 mg/dL [P = .002]), as was hospital length of stay (5.17 vs 4.6 days, [P = .024]). Conclusions: A decreased bedtime correctional insulin scale had mixed results with more patients achieving goal fasting BG but also more patients experiencing BG > 250 mg/dL and longer length of stay. Larger prospective studies are required to evaluate the safety and efficacy of this type of intervention and its long-term impact.
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Affiliation(s)
- Allacyn Hiscox
- Ambulatory Care Clinical Pharmacist Practitioner, Veteran Health Indiana, Indianapolis, IN, USA
| | - Jennifer Armbrust
- Geriatrics Clinical Pharmacy Specialist, Robley Rex Veterans Affairs Medical Center, Louisville, KY, USA
| | - Maria Shin
- Internal Medicine Clinical Pharmacist Practitioner, Robley Rex Veterans Affairs Medical Center, Louisville, KY, USA
| | - Jeffrey Bahng
- Oncology Clinical Research Pharmacist, Norton Cancer Institute - St. Matthews, Louisville, KY, USA
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2
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Snoswell CL, De Guzman KR, Barras M. Advanced-scope pharmacist roles in medical outpatient clinics: a cost-consequence analysis. Intern Med J 2024; 54:404-413. [PMID: 38050932 DOI: 10.1111/imj.16280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/19/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND There is a growing body of evidence that supports the clinical effectiveness of pharmacist roles in outpatient settings. However, limited studies have investigated the economic efficiency of advanced-scope outpatient pharmacist roles, particularly in the Australian setting. Assessing the overall costs and benefits of these outpatient pharmacist roles is needed to ensure service sustainability. AIMS To use a cost-consequence approach to evaluate the advanced-scope outpatient pharmacist roles across multiple clinic disciplines from the hospital perspective. METHODS A cost-consequence analysis was undertaken using data from a previous clinical-effectiveness study. All outpatient pharmacist consults conducted from 1 June 2019 to 31 May 2020 across 18 clinic disciplines were evaluated. Consequences from the pharmacist services included number of consults conducted, number of medication-related activities and number of resolved recommendations. RESULTS The overall cost to the hospital for the outpatient pharmacist service across all clinics was AU$1 991 122, with a potential remuneration of AU$3 895 247. There were 10 059 pharmacist consults undertaken for the 12-month period. Medication-related activities performed by pharmacists primarily included 6438 counselling and education activities and 4307 medication list activities. When the specialist pharmacist roles were added to the outpatient clinics, several health service benefits were also realised. CONCLUSIONS The addition of pharmacist roles to outpatient clinics can increase the cost of services; however, they also can increase medication optimisation activities. Future research should examine a societal perspective that includes broader cost and effectiveness outcomes. This study could justify the implementation of advanced-scope outpatient pharmacist roles in other Australian hospitals.
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Affiliation(s)
- Centaine L Snoswell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Keshia R De Guzman
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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Ibarra F. Safety and Effectiveness of a Standardized Intravenous Insulin Infusion Order Set for Managing Uncontrolled Hyperglycemia Outside the Intensive Care Unit. Ann Pharmacother 2024; 58:241-247. [PMID: 38084454 DOI: 10.1177/10600280231178876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Few studies have evaluated the administration of intravenous (IV) insulin infusions for uncontrolled hyperglycemia in non-intensive care unit (ICU) patients, and there is inadequate data to guide how to appropriately administer IV insulin infusions to this patient population. OBJECTIVE Determine the effectiveness and safety of our institution's non-critical care IV insulin infusion order set. METHODS This retrospective study was conducted at 2 institutions within a health care system. The primary outcome was the number of individuals who achieved a glucose level ≤180 mg/dL. For those meeting this endpoint, the time to achieving this outcome and the percentage of glucose checks within the goal range were determined. The primary safety endpoint was the number of individuals who experienced hypoglycemia (glucose level <70 mg/dL). Patients were included if they were ≥18 years of age and received the non-critical care IV insulin infusion order set outside of the ICU. RESULTS Twenty-one (84%) patients achieved a glucose level ≤180 mg/dL. The median (inter-quartile range [IQR]) time to achieving the primary outcome was 5.7 h (3.9-8.3). In patients who achieved the primary outcome, 41.8% of the glucose readings obtained after achieving this outcome were within goal range. Two (8%) patients experienced hypoglycemia. Both of these events occurred within 8 hours of therapy initiation and neither patient received prior doses of subcutaneous insulin. Of the 4 patients who did not achieve a glucose level ≤180 mg/dL, 2 received high-dose corticosteroids, and 3 achieved a glucose level between 181 and 200 mg/dL. CONCLUSION AND RELEVANCE Our findings support the safe administration of IV insulin infusions to non-ICU patients when targeting a glucose range of 140 to 180 mg/dL and limiting the infusion duration.
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Affiliation(s)
- Francisco Ibarra
- Department of Pharmacy Services, Community Regional Medical Center, Fresno, CA, USA
- College of Osteopathic Medicine, California Health Sciences University (CHSU), Clovis, CA, USA
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Snoswell CL, De Guzman KR, Barras M. Pharmacists reducing medication risk in medical outpatient clinics: a retrospective study of 18 clinics. Intern Med J 2023; 53:95-103. [PMID: 34487409 DOI: 10.1111/imj.15504] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/04/2021] [Accepted: 08/25/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The role of pharmacists in hospital inpatient settings is well recognised; however, pharmacists are relatively new to outpatient clinic settings in Australia. Evidence to justify the clinical effectiveness of pharmacists, in terms of identifying and resolving medication-related problems in an outpatient setting in Australia is limited. AIMS To investigate the clinical effectiveness of outpatient clinic pharmacists across multiple medical disciplines. METHODS A retrospective observational study was conducted by auditing medical records for patients who had an outpatient clinic pharmacist consult between June 2019 and February 2020 in a large quaternary hospital. All pharmacist recommendations targeting a medication-related problem were audited. Recommendations were considered 'resolved' if accepted and actioned by the patient and/or a clinician. The resolved recommendations were risk rated using a validated tool for medication-related patient harm. RESULTS There were 18 clinic pharmacist roles across multiple medical disciplines, of which 46 pharmacists conducted outpatient consults. A total of 7599 consults was conducted and a purposeful random sample of 572 (8%) consults was audited for 552 unique patients. There were 399 recommendations recorded in the notes by clinic pharmacists, a mean (standard deviation) of 0.95 (0.97) per patient. Of these, 328 (82%) were resolved; 269 (82%) were classified as low or moderate risk and 59 (18%) were classified as high-risk recommendations. CONCLUSIONS Clinic pharmacists in multidisciplinary outpatient clinics are effective at identifying and resolving medication-related problems. Our research demonstrated that 18% of these resolved recommendations prevented a high-risk medication-related harm event.
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Affiliation(s)
- Centaine L Snoswell
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Keshia R De Guzman
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael Barras
- Pharmacy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
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Iflaifel MH, Lim R, Ryan K, Crowley C, Iedema R. Understanding safety differently: developing a model of resilience in the use of intravenous insulin infusions in hospital in-patients-a feasibility study protocol. BMJ Open 2019; 9:e029997. [PMID: 31296514 PMCID: PMC6624105 DOI: 10.1136/bmjopen-2019-029997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using intravenous insulin infusions as well as the problems experienced are well described in the scientific literature. Traditional approaches for improving patient safety have focused on identifying errors, understanding their causes and designing solutions to prevent them. Such approaches do not take into account the complex nature of healthcare systems, which cannot be controlled solely by following standards. An emerging approach called Resilient Healthcare proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed. METHODS AND ANALYSIS The study will be conducted at Oxford University Hospitals NHS Foundation Trust and will involve three phases. Phase I: explore how work is imagined by analysing intravenous insulin infusion guidelines and conducting focus group discussions with guidelines developers, managers and healthcare practitioners. Phase II: explore the interplay between how work is imagined and how work is performed using mixed methods. Quantitative data will include blood glucose levels, insulin infusion rates, number of hypoglycaemic and hyperglycaemic events from patients' electronic records. Qualitative data will include video reflexive ethnography: video recording healthcare practitioners using intravenous insulin infusions and then conducting reflexive meetings with them to discuss selected video footage. Phase III: compare findings from phase I and phase II to develop a model for using intravenous insulin infusions. ETHICS AND DISSEMINATION Ethical approvals have been granted by the South Central-Oxford C Research Ethics Committee, Oxford University Hospitals NHS Foundation Trust and University of Reading. The results will be disseminated through presentations at appropriate conferences and meetings, and publications in peer-reviewed journals.
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Affiliation(s)
- Mais Hasan Iflaifel
- Reading School of Pharmacy, Whiteknights, Reading, University of Reading, Reading, Berkshire, UK
| | - Rosemary Lim
- Reading School of Pharmacy, Whiteknights, Reading, University of Reading, Reading, Berkshire, UK
| | - Kath Ryan
- Reading School of Pharmacy, Whiteknights, Reading, University of Reading, Reading, Berkshire, UK
| | - Clare Crowley
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Rick Iedema
- Centre for Team Based Practice & Learning in Health Care, King's College London, London, UK
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Donihi AC, Moorman JM, Abla A, Hanania R, Carneal D, MacMaster HW. Pharmacists' role in glycemic management in the inpatient setting: An opinion of the endocrine and metabolism practice and research network of the American College of Clinical Pharmacy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Amy C. Donihi
- Clinical Pharmacist, University of Pittsburgh Medical Center and Associate Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh Pennsylvania
| | - John M. Moorman
- Pharmacotherapy Specialist, Endocrinology, Cleveland Clinic Akron General and Associate Professor of Pharmacy Practice Northeast Ohio Medical University Akron Ohio
| | - Alicia Abla
- Clinical Pharmacist, Oklahoma Heart Hospital Oklahoma City Oklahoma
| | - Raja Hanania
- Clinical Pharmacy Specialist, Critical Care, Indiana University Health Bloomington Bloomington Indiana
| | - Dustin Carneal
- Clinical Pharmacy Specialist and Pharmacy Internship Coordinator, Alliance Community Hospital Alliance Ohio
| | - Heidemarie Windham MacMaster
- Diabetes Management Specialist, Institute for Nursing Excellence, UCSF Medical Center and Associate Clinical Professor, UCSF School of Pharmacy San Francisco California
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Bain A, Kavanagh S, McCarthy S, Babar Z. Assessment of Insulin-related Knowledge among Healthcare Professionals in a Large Teaching Hospital in the United Kingdom. PHARMACY 2019; 7:pharmacy7010016. [PMID: 30704103 PMCID: PMC6473239 DOI: 10.3390/pharmacy7010016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 11/23/2022] Open
Abstract
Despite numerous strategies introduced to promote the safe use of insulin, insulin-related medication errors persist. Our aim was to examine the knowledge and self-reported confidence of a range of healthcare professionals regarding insulin use in a large teaching hospital in the North of England. A 16-item electronic questionnaire was prepared in light of locally reported insulin-related incidents and distributed electronically to all healthcare professionals at the hospital over a 4-week study period. A range of healthcare professionals, including nurses, pharmacists, pharmacy technicians, junior doctors and consultants, completed the questionnaires (n = 109). Pharmacists achieved the greatest percentage of mean correct answers overall (49%), followed by consultant doctors (38%) and pharmacy technicians (37%), junior doctors (34%) and nurses (32%). Healthcare professionals were mainly “slightly confident” in their knowledge and use of insulin. Confidence level positively correlated to performance, but number of years’ experience did not result in higher confidence or performance. This small-scale study allowed for a broad assessment of insulin-related topics that have been identified both nationally and locally as particularly problematic. Identifying knowledge gaps may help tailor strategies to help improve insulin knowledge and patient safety.
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Affiliation(s)
- Amie Bain
- School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK.
| | - Sallianne Kavanagh
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK.
| | - Sinead McCarthy
- School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
| | - Zaheer Babar
- School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
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Harada S, Suzuki A, Nishida S, Kobayashi R, Tamai S, Kumada K, Murakami N, Itoh Y. Reduction of medication errors related to sliding scale insulin by the introduction of a standardized order sheet. J Eval Clin Pract 2017; 23:582-585. [PMID: 27928867 DOI: 10.1111/jep.12674] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 11/29/2022]
Abstract
Insulin is frequently used for glycemic control. Medication errors related to insulin are a common problem for medical institutions. Here, we prepared a standardized sliding scale insulin (SSI) order sheet and assessed the effect of its introduction. Observations before and after the introduction of the standardized SSI template were conducted at Gifu University Hospital. The incidence of medication errors, hyperglycemia, and hypoglycemia related to SSI were obtained from the electronic medical records. The introduction of the standardized SSI order sheet significantly reduced the incidence of medication errors related to SSI compared with that prior to its introduction (12/165 [7.3%] vs 4/159 [2.1%], P = .048). However, the incidence of hyperglycemia (≥250 mg/dL) and hypoglycemia (≤50 mg/dL) in patients who received SSI was not significantly different between the 2 groups. The introduction of the standardized SSI order sheet reduced the incidence of medication errors related to SSI.
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Affiliation(s)
- Saki Harada
- Department of Pharmacy, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Akio Suzuki
- Department of Pharmacy, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Shohei Nishida
- Department of Pharmacy, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Ryo Kobayashi
- Department of Pharmacy, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Sayuri Tamai
- Patient Safety Division, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Keisuke Kumada
- Patient Safety Division, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Nobuo Murakami
- Patient Safety Division, Gifu University Hospital, Yanagido, Gifu, Japan
| | - Yoshinori Itoh
- Department of Pharmacy, Gifu University Hospital, Yanagido, Gifu, Japan
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10
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Forough AS, Esfahani PR. Impact of Pharmacist Intervention on Appropriate Insulin Pen Use in Older Patients with Type 2 Diabetes Mellitus in a Rural Area in Iran. J Res Pharm Pract 2017; 6:114-119. [PMID: 28616435 PMCID: PMC5463546 DOI: 10.4103/jrpp.jrpp_16_151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of pharmacist-conducted educational intervention on reducing errors related to inappropriate insulin pen use. METHODS This was a prospective, before-after study with an educational intervention component. The study was conducted on 122 elderly diabetic patients. Data were collected through interviews using researcher-administered questionnaires as well as patients' medical records. Patients were asked about the preparation, injection, and storage techniques, they followed when using insulin pens. Blood glucose parameters were extracted from laboratory records. After the detection of errors, patients and their caregivers were instructed about the insulin pen use by the pharmacist. Patients were reevaluated after 12 weeks. FINDINGS Patients' mean age was 67.2 ± 3.5 with male: female ratio of 71:51. Mean diabetes duration was 7.1 ± 2.8 years. Fifty-four patients (44.2%) stated that they had received instructions for insulin pen use previously. The majority of this group (24 cases, 44.4%) reported that the instructions were given by a pharmacist. The mean number of errors decreased from 3.99 ± 0.22 errors per patient to 1.49 ± 0.13 errors (odds ratio: 0.28, 95% confidence interval: 0.23-0.33,P < 0.05). Of eleven evaluated insulin pen-related medication error items, nine items experienced a significant decrease after patient education. Fasting plasma glucose (FPG) levels decreased significantly from 161.7 ± 12.5 to 147.3 ± 13.1 mg/dL (P < 0.05). However, glycated hemoglobin levels did not change significantly after 3 months (P = 0.18). Controlled FPG had a significant rise from 45% before education to 63.9% postintervention (P < 0.05). CONCLUSION Pharmacists can play an important role in safe and efficient use of insulin pen in elderly diabetic patients by minimizing the likelihood of medication errors associated with insulin pen use.
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Affiliation(s)
- Aida Sefidani Forough
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia.,Department of Pharmaceutical Care, Amiralmomenin Hospital, Khodabandeh, Iran
| | - Parsa Riazi Esfahani
- National Organization for Development of Exceptional Talents (NODET), Tehran, Iran
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Brown KE, Hertig JB. Determining Current Insulin Pen Use Practices and Errors in the Inpatient Setting. Jt Comm J Qual Patient Saf 2016; 42:568-AP7. [PMID: 28334561 DOI: 10.1016/s1553-7250(16)30109-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The use of insulin pens in the inpatient setting has continued to be a controversial decision. Insulin pens provide several advantages, but given significant reports of medication errors, several organizations have issued alerts to caution users about safety concerns. A survey was conducted to assess the prevalence of insulin pen use and current utilization trends in the inpatient setting. METHODS The 31-question guided-logic survey was developed based on review of primary literature regarding insulin pen utilization and evaluated by a panel of medication safety experts from a variety of health care settings. The survey was sent electronically to subscribers of medication safety organizations. RESULTS The survey was completed by 474 respondents. Approximately three fourths of respondents indicated insulin pens were on formulary at their institution (n = 332; 74%). Of those who have had insulin pens on formulary, 15% (n = 49) are no longer using them. The most common reasons for not utilizing pens were cost and safety concerns. Pens were reported to be stored in the pharmacy prior to administration (n = 230; 78%) and in a patient's bin (n = 202; 69%) afterward. More than half of respondents use two patient identifiers on the pen and label with a bar code. Approximately 30% reported that an insulin pen has been used on more than one patient at least once in their institution, while 6% were not sure. CONCLUSION Insulin pens are widely being used in the inpatient setting. Various mitigation strategies are employed to reduce the risk of harm associated with insulin pen use. Health care professionals believe insulin pens are clinically useful and can be used safely in the inpatient setting. Many organizations and expert panels disseminate best practices in an effort to help ensure their safety. Further studies are needed to assess and validate the risk mitigation strategies identified through this research.
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Affiliation(s)
- Katelyn E Brown
- Formerly Regulatory Pharmaceutical Fellow in Medication Safety, Purdue University, Indianapolis; Therapeutic Consultant for Diabetes in US Health Outcomes, Eli Lilly and Company, Indianapolis.
| | - John B Hertig
- Associate Director, Center for Medication Safety Advancement; Courtesy Clinical Assistant Professor of Pharmacy Practice, Purdue University, Indianapolis; Member, Editorial Advisory Board, The Joint Commission Journal on Quality and Patient Safety
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Lutz MF, Haines ST, Lesch CA, Szumita PM. Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program. Am J Health Syst Pharm 2016; 73:S17-31. [PMID: 27647095 DOI: 10.2146/ajhp160417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of the MENTORED QUALITY IMPROVEMENT IMPACT PROGRAM℠ (MQIIP) on Ensuring Insulin Pen Safety in Hospitals, which was part of an ASHP educational initiative aimed at ensuring the safe use of insulin pens in hospitals, are described. METHODS During this ASHP initiative, which also included continuing-education activities and Web-based resources, distance mentoring by pharmacists with expertise in the safe use of insulin pens was provided to interprofessional teams at 14 hospitals between September 2014 and May 2015. The results of baseline assessments of nursing staff knowledge of insulin pen use, insulin pen storage and labeling audits, and insulin pen injection observations conducted in September and October 2014 were the basis for insulin pen quality-improvement plans. Postintervention data were collected in April and May 2015. RESULTS Compared with the baseline period, significant improvements in nurses' knowledge of insulin pen use, insulin pen labeling and storage, and insulin pen administration were observed in the postintervention period despite the relatively short time frame for implementation of quality-improvement plans. Program participants are committed to sustaining and building on improvements achieved during the program. The outcome measures described in this report could be adapted by other health systems to identify opportunities to improve the safety of insulin pen use. CONCLUSION Focused attention on insulin pen safety through an interprofessional team approach during the MQIIP enabled participating sites to detect potential safety issues based on collected data, develop targeted process changes, document improvements, and identify areas requiring further intervention. A sustained organizational commitment is required to ensure the safe use of insulin pen devices in hospitals.
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Nguyen CT, Seto A, Rushakoff R, MacMaster HW. Pharmacists' Impact on Glycemic Control Among Surgical Patients at a Large Academic Institution. Clin Diabetes 2016; 34:105-8. [PMID: 27092021 PMCID: PMC4833484 DOI: 10.2337/diaclin.34.2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Cynthia T. Nguyen
- Department of Pharmaceutical Services, University of California, San Francisco Medical Center
| | - Anna Seto
- Department of Pharmaceutical Services, University of California, San Francisco Medical Center
| | - Robert Rushakoff
- Division of Endocrinology and Metabolism, University of California, San Francisco
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Zhao RY, He XW, Shan YM, Zhu LL, Zhou Q. A stewardship intervention program for safe medication management and use of antidiabetic drugs. Clin Interv Aging 2015; 10:1201-12. [PMID: 26229454 PMCID: PMC4516029 DOI: 10.2147/cia.s87456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team’s integrated endeavors to enhance safe medication management and use of antidiabetic drugs. Methods A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People’s Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually. Results The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly “look-alike” and “sound-alike” NovoMix 30® (biphasic insulin aspart) and NovoRapid® (insulin aspart) has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011) to 96% (fourth quarter 2011) (P<0.05). The number of medication administration errors related to insulin continuously decreased from 20 (2011) to six (2014). The occurrence rate of hypoglycemia in non–endocrinology ward diabetes inpatients during 2011–2013 was significantly less than that in 2010 (5.03%–5.53% versus 8.27%) (P<0.01). Percentage of correct management of hypoglycemia by nurses increased from 41.5% (April 2014) to 67.2% (August 2014) (P<0.01). The percentage of outpatient diabetes patients receiving standard insulin injection education increased from 80% (April 2012) to 95.2% (October 2012) (P<0.05). Insulin injection techniques among diabetes outpatients who started to receive insulin were better than indicated in data from two questionnaire surveys in the literature, including the percentage checking injection sites prior to injection (85.6%), priming before injection (98.1%), rotation of injecting sites (98.1%), remixing before use (94.5%), keeping the pen needle under the skin for >10 seconds (99.4%), and using the pen needle only once (88.7%). On-site inspection indicated of great improvement in the percentage of drug-related problems in the antidiabetes regimen between the first and second quarter of 2014 (1.08% versus 0.28%) (P<0.05). Conclusion Quality improvements in safe medication management and use of antidiabetic drugs can be achieved by multidisciplinary collaboration among pharmacists, nurses, physicians, and information engineers.
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Affiliation(s)
- Rui-yi Zhao
- Clinical Nurse Specialist Section, Division of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiao-wen He
- Clinical Nurse Specialist Section, Division of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yan-min Shan
- Clinical Nurse Specialist Section, Division of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Ling-ling Zhu
- Geriatric VIP Care Ward, Division of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Quan Zhou
- Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
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Cobaugh DJ, Maynard G, Cooper L, Kienle PC, Vigersky R, Childers D, Weber R, Carson SL, Mabrey ME, Roderman N, Blum F, Burkholder R, Dortch M, Grunberger G, Hays D, Henderson R, Ketz J, Lemke T, Varma SK, Cohen M. Enhancing insulin-use safety in hospitals: Practical recommendations from an ASHP Foundation expert consensus panel. Am J Health Syst Pharm 2014; 70:1404-13. [PMID: 23903479 DOI: 10.2146/ajhp130169] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Consensus recommendations to help ensure safe insulin use in hospitalized patients are presented. SUMMARY Insulin products are frequently involved in medication errors in hospitals, and insulin is classified as a high-alert medication when used in inpatient settings. In an initiative to promote safer insulin use, the American Society of Health-System Pharmacists (ASHP) Research and Education Foundation convened a 21-member panel representing the fields of pharmacy, medicine, and nursing and consumer advocacy groups for a three-stage consensus-building initiative. The panel's consensus recommendations include the following: development of protocol-driven insulin order sets, elimination of the routine use of correction/sliding-scale insulin doses for management of hyperglycemia, restrictions on the types of insulin products stored in patient care areas, and policies to restrict the preparation of insulin bolus doses and i.v. infusions to the pharmacy department. In addition, the panelists recommended that hospitals better coordinate insulin use with meal intake and glucose testing, prospectively monitor the coordination of insulin delivery and rates of hypoglycemia and hyperglycemia, and provide standardized education and competency assessment for all hospital-based health care professionals responsible for insulin use. CONCLUSION A 21-member expert panel convened by the ASHP Foundation identified 10 recommendations for enhancing insulin-use safety across the medication-use process in hospitals. Professional organizations, accrediting bodies, and consumer groups can play a critical role in the translation of these recommendations into practice. Rigorous research studies and program evaluations are needed to study the impact of implementation of these recommendations.
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Affiliation(s)
- Daniel J Cobaugh
- American Society of Health-System Pharmacists Research and Education Foundation, Bethesda, MD 20814, USA.
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Cornish W. Safe and Appropriate Use of Insulin and Other Antihyperglycemic Agents in Hospital. Can J Diabetes 2014; 38:94-100. [DOI: 10.1016/j.jcjd.2014.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022]
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An Interprofessional Qualitative Study of Barriers and Potential Solutions for the Safe Use of Insulin in the Hospital Setting. Can J Diabetes 2014; 38:85-9. [DOI: 10.1016/j.jcjd.2014.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/19/2014] [Accepted: 01/26/2014] [Indexed: 11/19/2022]
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Monroe PS, Heck WD, Lavsa SM. Changes to medication-use processes after overdose of U-500 regular insulin. Am J Health Syst Pharm 2012; 69:2089-93. [DOI: 10.2146/ajhp110628] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Wendy D. Heck
- University of Texas M. D. Anderson Cancer Center, Houston
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Affiliation(s)
- Paula Holt
- School of Healthcare, University of Leeds
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