Use Of Insulin Pens Research Articles

Is One-Pen, One-Patient Achievable in the Hospital? A Quality Improvement Project to Reduce Risks of Inadvertent Insulin Pen Sharing at a Large Academic Medical Center

The Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Institute for Safe Medicine Practices (ISMP) have issued warnings regarding the risk of potential transmission of blood-borne diseases if an insulin pen is used for more than one person. Many hospitals continue to use insulin pens due to their benefits of decreased risk of dosing error and improved work efficiency. Best practices for insulin pen use have been published; however, little is known about how these perform in hospitals. This article describes a multifaceted quality improvement project to address the safety issues of single-patient insulin pens. Major interventions included adding patient-specific bar coding on insulin pens, redesign of labels, systematic removal of discharged patients' medications, and ongoing staff education. Self-reported events of insulin pen sharing events over 40 months showed a significant increase in the number of patient-days between events. The significant change occurred after implementation of patient-specific bar code scanning. There was a gradual decrease in latent errors found during medication drawer audits, and nursing compliance with patient-specific bar code scanning improved over time, reaching 90% on the last recorded month. Of 35 expert recommendations for insulin pen safety, 28 directly affected pen sharing-8 had been implemented prior to this project, and 20 had been implemented by the conclusion. Insulin pen use is highly complex in hospital settings where multiple steps provide opportunities for error. To protect patients, all gaps need to be reviewed, and interventions that address major contributing factors are required to ensure safe insulin pen use.

Levels of Physical Activity in Children and Adolescents with Type 1 Diabetes in Relation to the Healthy Comparators and to the Method of Insulin Therapy Used.

Given the fact that physical exertion leads to blood glucose fluctuations, type one diabetes mellitus (T1D) may potentially constitute a barrier for obtaining a sufficient amount of exercise. The main purpose of the study was to compare the level of physical activity between children with T1D (n = 215) and healthy controls (n = 115) and to assess the physical activity of the study group in relation to the applied method of insulin therapy, i.e., the use of insulin pen vs. insulin pump. The level of physical activity was assessed with a hip-worn tri-axial accelerometer (ActiGraph GT3X+) used by the subjects for an uninterrupted period of seven days. Children with T1D had significantly lower median values of total time of moderate (213.3 vs. 272.1 min), vigorous (135.3 vs. 19.6 min) and moderate-to-vigorous (347.4 vs. 467.4 min) physical activity compared to healthy peers respectively, (p < 0.001) in all cases. In addition, the total median number of steps was significantly lower (53,631 vs. 67,542 steps), (p < 0.001). The method of insulin therapy was not associated with significant differences in physical activity level (p > 0.001). The level of physical activity in children and adolescents with T1D is lower than in their healthy peers and does not depend on the insulin therapy method.

Insulin pen use and diabetes treatment goals: A study from Iran STEPS 2016 survey.

BackgroundFrequency of insulin pen use, despite its higher costs, is increasing to substitute the traditional use of insulin vials. This study aims to report insulin pen use frequency and its associated factors among participants of the STEPS survey 2016 in Iran, which was conducted based on the World Health Organization (WHO) STEPS methodology.MethodsIn this cross-sectional study, 19,503 (mean age of 46.03±0.13) out of 30,541 participants of the Iran STEPS survey were included (Inclusion criteria: aged >25 years old and availability of their demographic, clinical, and laboratory results for serum glucose, HbA1c, and lipid profile). Clinical and demographic characteristics, a frequency of use of each diabetes mellitus treatment type, and the association of insulin pen use with health outcomes are reported using descriptive analysis and propensity score modeling.ResultsThere were 1,999(10.85%) individuals diagnosed with diabetes in the population, while 1,160(56.87%) cases were taking antihyperglycemic treatments. In this subset, 240(21.14%) individuals administered insulin with or without using oral agents at the same time. 52.28% of participants who were under insulin therapy used insulin pens. None of the socioeconomic determinants, including gender (p-value = 0.11), type of residential areas (p-value = 0.52), years of schooling (p-value = 0.27), wealth index (p-value = 0.19), marital status (p-value = 0.37), and insurance types (p-value = 0.72) were significantly different among groups using insulin pens and insulin vials. Moreover, in the propensity score modeling, pen usage was not associated with a lower heart attack and ischemic stroke histories, systolic blood pressure, serum lipid profile, blood glucose, or HbA1c levels.ConclusionResults showed that the use of the higher-costing insulin pens compared to traditional vials and syringes is not associated with improved glycemic control and better lipid profile in our sample. Future studies are needed to confirm these findings and to compare other aspects of insulin pen use, including adherence to treatment and cost-effectiveness.

1070-P: Assessment of Effectiveness and Satisfaction of Use of the Automatic Injection System GensuPen 2

Success in treating diabetes is highly dependent on the patient's satisfaction with the therapy. The aim of the study was to assess the effectiveness and satisfaction of the use of Automatic Injection System GensuPen2 device which is a pen with a spring-assisted insulin release mechanism and a laterally located trigger. 4707 adult insulin treated diabetic patients (50.44% women) from all over Poland took part in the study. For 42% of subjects, the previously used pen was changed to the GensuPen2. During the first visit demographic and medical data were gathered. HbA1c was measured and the questionnaires concerning the satisfaction with the currently used pen and evaluation of pain severity, satisfaction with the treatment (all three are 5-point scales), and the health-related quality of life (HRQoL) were filled out twice - at the beginning and after 12 weeks of the study. The mean age was 64.8±10.1 years and duration of diabetes was 9.9±6.5 years. Impaired visual function was found in 13.7% and 12.3% of the subjects had an impaired manual efficiency. After 12 weeks, HbA1c level dropped from 8.26±1.17% to 7.72±0.89% (P &amp;lt;0.001). Satisfaction with the use of pen increased from on average 3.33 to 4.31 points (P &amp;lt;0.001) after switching to GensuPen2. Evaluation of pain severity revealed that discomfort and pain related to insulin injection decreased from on average 3.82 to 2.41 points (P &amp;lt;0.001). Insulin therapy with the use of GensuPen2 was comfortable for 94.48% of patients. More than half of the patients were more satisfied with GensuPen2 than with the previously used pen, and 98.63% of subjects declared that they did not want to return to previous pen. Satisfaction with diabetes treatment raised from 81.2% to 94.5% (P &amp;lt;0.001). The HRQoL increased from on average 5.81 to 7.39 points (P &amp;lt;0.001). The use of the GensuPen2 by diabetes patients improved metabolic control, increased satisfaction with diabetes treatment and the use of insulin pen, reduced the pain during injection, and improved their quality of life. Disclosure K. Cypryk: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk A/S. Speaker's Bureau; Self; Abbott, Servier. M. Zurawska-Klis: Speaker's Bureau; Self; Polfa Tarchomin S.A. Other Relationship; Self; Berlin-Chemie AG, Lilly Diabetes, Novo Nordisk Inc. Funding Bioton

Smart Connected Insulin Pens, Caps, and Attachments: A Review of the Future of Diabetes Technology.

The evolution of technologies to manage diabetes has led to improvements in patient adherence, technique, and monitoring. Insulin pens, for example, have distinct advantages over vials and syringes; they allow for more accurate dosing, improved adherence, less injection site pain, and greater patient satisfaction (1,2). As the population with diabetes grows internationally, second-generation insulin pens have been engineered with USB or Bluetooth features to enable closer monitoring of pharmacotherapy. Similarly, many devices for self-monitoring of blood glucose have also become integrated with Bluetooth to enable wireless transmission of data to a smartphone. As of 2016, the smart insulin pen market was valued at $59 million and is expected to increase to $123 million by 2023 in Latin America, the Middle East, and Africa (3). One report predicts that Europe will have the greatest smart insulin pen market growth, bringing in more than $2 million by 2027, based in part on high current utilization of such pen devices. The trend toward increased use of smart insulin pens can also be seen in North America; in fact, the same report estimates that, by 2027, the North American smart insulin pen market will have a continuous annual growth rate of 26.7% (4). The emergence of new technologies such as smart insulin pens, caps, attachments, and virtual platforms can help both patients and health care providers (HCPs) overcome problems such as poor insulin adherence, incorrect insulin initiation and titration, and medication errors. Adoption of such new devices may increase even further if clinical trials can show long-term cost-effectiveness (5). This review highlights the technologies now available on the market in the United States and internationally that are designed to improve insulin administration. A comprehensive literature review was conducted using manufacturer websites, press releases, commercial data resources, educational and training tools, …

Student pharmacists' service-oriented learning at a camp for children with type 1 diabetes mellitus

Background and purposeTo describe advanced pharmacy practice experience (APPE) students' active learning engagement and changes in self-reported comfort with diabetes care activities by attending an overnight camp for children with type 1 diabetes mellitus (T1DM). Educational activity and settingFourth-year pharmacy students spend one or two weeks at an overnight camp for children ages six to 18 years with T1DM as part of their APPE and assist with diabetes care activities while participating in daily living activities. Students complete a survey one week before and one week after camp where they self-report their comfort level performing 16 different diabetes-related tasks. FindingsStudents (n = 21) participate in hands-on active learning while volunteering at a camp for children with diabetes. Before camp, 40–61% of students reported comfort with diabetes care activities related to pharmacotherapy, monitoring, and lifestyle management. After camp, the percent of students reporting comfort with these tasks increased to 78–96%. Specific items with greatest improvement were: when to monitor ketone levels (+79%), use of insulin pens and pumps (+64%), treatment of hypoglycemia (+50%), and carbohydrate counting (+50%). SummaryBy attending and participating at an overnight camp for children with T1DM, APPE students self-report gain in comfort in performing many diabetes care-related tasks.

Lack of Treatment Persistence and Treatment Nonadherence as Barriers to Glycaemic Control in Patients with Type 2 Diabetes.

Treatment persistence (continuing to take medication for the prescribed period) and treatment adherence (complying with the prescription in terms of drug schedules and dosage) are both important when treating chronic diseases such as type 2 diabetes (T2D). They can be indicators of patient satisfaction with treatment. In T2D, the achievement of optimal outcomes requires both persistence with and adherence to prescribed therapy. Poor persistence with and adherence to T2D medication can have profound consequences for the patient, including non-achievement of glycaemic goals and an increased risk of long-term complications and mortality. Therefore, poor treatment persistence and adherence may also have economic consequences, including increased healthcare resource utilization and healthcare costs. Treatment persistence and adherence are affected by several factors, including the mode of administration, administration frequency/regimen complexity, and patient expectations. The aims of this review are as follows: to provide an overview of persistence with and adherence to different antidiabetes therapies for patients with T2D in the real-world setting; examine factors contributing to poor treatment persistence and adherence; and assess available data on the impact of poor treatment persistence and/or adherence on clinical and economic outcomes. Numerous potential targets for improving treatment persistence and/or adherence are identified, including developing less complex treatment regimens with lower pill burdens or less frequent injections, improving the convenience of drug-delivery systems, such as the use of insulin pen devices rather than the conventional vial and syringe, and developing therapies with an improved safety profile to alleviate patient fears of adverse effects, such as weight gain and risk of hypoglycaemia.Funding: Sanofi.

Do patients with diabetes use the insulin pen properly?

This study was conducted to evaluate the insulin pen application knowledge and skills of patients with diabetes. In our descriptive study, 200 patients with diabetes were asked to present the insulin pen injection technique on a mannequin and the steps of the pen injection implementation were noted on the data collection form as correct/incorrect by researchers. More than 3 out of 4 (79.5%) of the participants were using the insulin pen or the cartridge after the expiry date, 70.5% were not rotating the injection site, and 63.0% were massaging the skin after injection. Injection sites complications were significantly more in those who were using the insulin pen or the cartridge after the expiry date, those who don't know the proper length of the needle and the possible body injection sites, those who don't rotate the injection sites, those who massage after injection, and those who don't use a new needle at each injection (p<0.05). This study put into light some failures in the knowledge and skills of patients with diabetes regarding insulin pen use. Nurses should provide patients with diabetes an effective and repetitive training concerning insulin pen use.

The Pattern of Insulin Initiation and Common Errors of Insulin Pen Use in Patients with Type-2 Diabetes

The Pattern of Insulin Initiation and Common Errors of Insulin Pen Use in Patients with Type-2 Diabetes

Analysis on the status quo of the standardization of insulin pen use in nonspecialist diabetic patients by quality control circle

Objective To explore the role of quality control circle activity in regulating the use of insulin pen in with non-specialist diabetes mellitus. Methods Quality control circle group was set up.The theme of to improve the standard rate of using insulin pen in non specialist diabetes patients was carried out.Through the investigation of the current situation, the causes of nonstandard use of insulin pen were analyzed, and the effect was evaluated after 4 months. Results After quality control circle activity, the patients' standard using insulin pen rate was increased from 24.62% to 75.00%, and the difference was statistically significant(P<0.01). The knowledge of insulin injection of non-specialist nurses was significantly higher than that before activity, and the difference was statistically significant(P<0.01). The activity target achievement rate was 109.26%, and the progress rate was 66.83%.The comprehensive quality score of circle members was better than that before the activity. Conclusions Quality control circle activities can effectively regulate the use of insulin pen in non specialist diabetics, and improve the comprehensive quality of nursing staffs. Key words: Quality control circles; Non specialist diabetes patients; Using insulin pen; Standard rate

Assessment of Insulin Injection Practice of Nurses Working in a Tertiary Healthcare Center of Nepal.

Introduction Sound knowledge and good practice on insulin injection technique are essential for nurses in order to administer insulin correctly and to educate patients or their relatives adequately. This study aimed to assess the insulin injection practice through the use of insulin pen among nurses working in a tertiary healthcare center of Nepal. Materials and Methods A cross-sectional descriptive study was conducted among 67 nurses working in one of the tertiary healthcare centers of Nepal. Demographic information and insulin injection practice of nurses through the use of insulin pen were assessed using self-administered questionnaire. Each correct practice was scored “1” and incorrect practice was scored “0.” Results. The median (IQR) insulin injection practice score of nurses was 11 (9-12) out of 16. Thirty-seven (55.2%) nurses store insulin pen filled with insulin cartridge at room temperature while 57 (85.1%) nurses store unopened cartridge at refrigerator (2-8°C). The practice of hand washing and injection site cleaning was mentioned by 92.5% and 82.1% of the nurses, respectively. However, just over half of the nurses mix the premix (cloudy) insulin and prime insulin pen before each injection. Thirty-four (50.7%) nurses do not lift skin during injection and more than half of the nurses keep needle beneath the skin for less than 5 seconds after completely injecting the required dose of insulin. One out of ten nurses massage injection site after injecting insulin. Most of the nurses (86.6%) use single needle more than once and the median (IQR) frequency of needle reuse was 6 (3-12). Similarly, systematic site rotation was performed by 59 (88.1%) nurses and twenty (29.9%) nurses claim that they use single insulin pen for two different cartridges. Conclusion The insulin injection practice of nurses assessed through the use of insulin pen was suboptimal and highlights the need for urgent educational intervention.

Inpatient Use of Insulin Pens—Eliminating Risk for Inappropriate Use of Pen on More than One Patient

Use of insulin pens for inpatient insulin administration is accurate and safe. However, if the pen is used on more than one patient, there is potential risk of infection with pathogens including hepatitis viruses and HIV. Rapid-acting insulin (RAI) is a time-critical medication, both for correctional and nutritional doses. Many hospitals using insulin pens choose to dispense them with a patient specific ID barcode from the pharmacy. This workflow ensures the correct patient ID for scanning, yet it may result in dispensing duplicates and may create time-critical delays. At UCSF, automated dispensing machines (ADM) on adult-units house time-critical medications, including RAI. In this workflow, the RN labels the insulin pen with the patient specific 3D barcode generated on the unit. Prior to insulin pen administration, 3 barcodes must be scanned: 1. Patient armband, 2. Patient label on insulin pen. (NEW) 3. Insulin pen manufacturer (confirms an active order for this type of insulin). The EMR will flash a screen size alert with a red stop sign and a warning if the patient’s armband ID and the pen label’s patient ID do not match. Implemented in 2/2017, this workflow and alert system, for the approximately 18,000 insulin pen SQ injections administered per month has triggered 10-25 alerts per month. As of 11/1/2017, all alerts have stopped the process and the correct patient’s insulin pen was retrieved and administered. Each alert is followed by an investigation. Significant factors contributing to the triggering of an alert involve RNs caring for &amp;gt;1 patient with RAI insulin orders, pens returned to the wrong patient specific cassette in centralized medication rooms, carrying &amp;gt; 1 patient’s insulin pen at a time and opening &amp;gt; 1 patient’s EMR in the patient’s room when scanning. We conclude that pen misuse can be avoided with compliance to our triple scanning system, in conjunction with best practices, while preserving the critical timing of rapid-acting insulin. Disclosure H.W. Macmaster: None. A. Maruoka: None. C. San Luis: None. S. Gonzalez: None. R.J. Rushakoff: None.

Benchmarking Insulin Treatment Persistence Among Patients with Type 2 Diabetes Across Different U.S. Payer Segments.

Treatment persistence with basal insulins is crucial to achieving sustained glycemic control, which is associated with a reduced risk of microvascular disease and other complications of type 2 diabetes (T2D). However, studies suggest that persistence with basal insulin treatment is often poor. To measure and benchmark real-world basal insulin treatment persistence among patients with T2D across different payer segments in the United States. This was a retrospective observational study of data from a national pharmacy database (Walgreen Co., Deerfield, IL). The analysis included patients with T2D aged ≥ 18 years who filled ≥ 1 prescription for basal insulins between January 2013 and June 2013 (the index prescription) and who had also filled prescriptions for ≥ 1 oral antidiabetes drug in the database. Patients with claims for premixed insulin were excluded. Treatment persistence was defined as remaining on the study medication(s) during the 1-year follow-up period. Patients were stratified according to treatment history (existing basal insulin users vs. new insulin users), payer segments (commercially insured, Medicare, Medicaid, or cash-pay), type of basal insulin (insulin glargine, insulin detemir, or neutral protamine Hagedorn insulin [NPH]), and device for insulin administration (pen or vial/syringe). A total of 274,102 patients were included in this analysis, 82% of whom were existing insulin users. In terms of payer segments, 45.3% of patients were commercially insured, 47.8% had Medicare, 5.9% had Medicaid, and 1.1% were cash-pay. At the 1-year follow-up, basal insulin treatment persistence rate was 66.8% overall, 61.7% for new users, and 67.9% for existing users. In general, for both existing and new basal insulin users, higher persistence rate and duration were associated with Medicare versus cash-pay patients, use of insulin pens versus vial/syringe, and use of insulin glargine versus NPH. This large-scale study provides a benchmark of basal insulin treatment persistence across different payers in the United States. Findings indicate that basal insulin persistence patterns are significantly different across different payers, basal insulin types, and devices. This information may be useful in developing targeted approaches to improve T2D patients' persistence with insulin treatment for better glycemic control. This study was funded by Sanofi U.S. through a grant provided to Walgreens for research services. Matusik, Jiang, and Lou are employed by Walgreen Co. Wei and Ganguli were employed by Sanofi U.S. at the time of this study. Study concept and design were contributed by Wei, Ganguli, and Matusik, with assistance from Lou. Jiang took the lead in data collection, along with Lou, and data interpretation was performed by Wei, Lou, and Jiang, along with Ganguli and Matusik. The manuscript was written by Wei and Jiang, along with Ganguli and Matusik, and revised by Wei and Ganguli, along with the other authors.

Impact of Pharmacist Intervention on Appropriate Insulin Pen Use in Older Patients with Type 2 Diabetes Mellitus in a Rural Area in Iran.

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.

Evaluation of Insulin Delivery Strategies for Bronson Health Group

Purpose: The Institute for Safe Medication Practices has published numerous safety alerts in regards to institutional insulin pen use focused on the misuse of insulin pens and subsequent transmission of infections. Other institutions may use floor-stock insulin; however, The Joint Commission has provided recent guidance against using multiuse vials on multiple patients. The purpose of this study is to evaluate Bronson Healthcare Group’s different methods of insulin administration to determine a cost-effective strategy while meeting regulatory requirements. Secondary endpoints will evaluate safety and nursing preference of different types of insulin delivery. Methods: Retrospective data was collected in the form of medication safety event forms, insulin purchasing records, hospital-wide insulin usage reports, number of patient-days reports, and a nursing survey. Insulin use, purchasing data, and safety event reports were collected from August 2013 to August 2014 from Bronson Methodist Hospital and Bronson Battle Creek Hospital. The nursing survey was distributed to inpatient Bronson facilities from January 22 to February 5, 2015. Aggregate data was collected and analyzed via Microsoft Excel. Descriptive statistics were used to evaluate the primary outcome. Chi squared and t-tests were used for secondary outcomes as appropriate. Results: By switching to short-acting insulin administered from 3 mL single-patient insulin lispro vials and pharmacy-drawn long-acting insulin detemir the hospital system could potentially save approximately $22,000 a year. Data did not support there being a safer method of insulin delivery. Nursing preference data indicated that nurses prefer delivery methods with which they are more familiar. Conclusion: In combination with recommended best safety practices as reported by multiple nationally recognized safety organizations, we can conclude that the most cost-effective methods of insulin delivery for the Bronson Health System would be pharmacy technician drawn single doses of long acting insulin detemir and single patient 3 mL vials of insulin lispro.

Determining Current Insulin Pen Use Practices and Errors in the Inpatient Setting

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. 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. 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. 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.

Best practices for safe use of insulin pen devices in hospitals: Recommendations from an expert panel Delphi consensus process.

A Delphi consensus development process was used to identify best practices for the safe use of insulin pen devices in hospitals. A panel of healthcare professionals with experience in patient safety activities and development of insulin-use guidelines was selected. In round 1 of a 4-round Delphi process, panelists were asked to identify key concepts and practices relating to safe use of insulin pen devices in hospitals. In round 2, panelists indicated their level of agreement with draft practice statements reflecting input received in round 1; statements with strong support were refined based on panelist suggestions. In round 3, the modified draft statements were rated for potential impact on patient safety. In round 4, panelists selected a final list of statements to recommend as best practices. A 12-member interprofessional panel consisting of nurses, pharmacists, and physicians participated in the Delphi process. In round 1, panelists submitted more than 450 statements describing safe practices for insulin pen use. Based on that input, 125 draft practice statements were developed; among 98 statements receiving panelist support in round 2, 76 were judged in round 3 to be critical to patient safety or likely to have a positive impact on patient safety. In round 4, panelists unanimously affirmed a final list of 35 best-practice statements for the safe use of insulin pens in hospitals. A Delphi consensus development process yielded a list of recommended best practices to help ensure the safe use of insulin pen devices in hospitals and health systems.

Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program.

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. 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. 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. 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.

Best Practices in Ensuring the Safe Use of Insulin Pens in the Hospital.

Best Practices in Ensuring the Safe Use of Insulin Pens in the Hospital.

Best practices in ensuring the safe use of insulin pens in the hospital: Introduction.

Hyperglycemia is common in hospitalized patients, and insulin is the preferred antihyperglycemic treatment in the inpatient setting.[1][1],[2][2] Insulin is a high-alert medication associated with a significant risk for patient harm when used incorrectly or inappropriately.[3][3] Numerous reports