b'Insulin Errors Potentially Plague Hospitals Treating Diabetes Patientscaredisparitiesandimprovepatient Pens reduce medication safety,andaprogramwasdevel- waste that can occur opedensuringthatallclinicianswhen dispensing 10 mL-couldco-manageU-500Rinsulin.sized insulin vials for Primarycareprovidersandothereach patient. cliniciansarerelativelyunfamiliarErrors related to pen design with this concentrated insulin formu- and injection technique have lation,accordingtostudyauthors.beenreported,however, Education plays a key role in the useaccordingtotheISMP.For of U-500R insulin for both cliniciansexample,Needlestickinju-and patients to ensure patient safety.ries have also been reported Akeytoimprovingpatientsafetyaftermisaligningtheangle with U-500R insulin includes the useof the injection, which allows ofthecorrectsyringeforthisinsu- theneedletotravelthrough lin. At the time of this program, nothe patients skin and into a U-500R insulin syringe existed, andnursesfinger.Inaddition, oftenU-100Rinsulinsyringeswereinsulin cartridges within pens used,resultinginerrors.Toavoidhavebeenmisusedasmul-potentialerrors,tuberculinsyringestiple-dosevialswhenstaff should have been used, and the dosewhopreferredtoadminister should have been written in units withinsulinusingaconventional the corresponding volume written insyringeattemptedtowith-milliliters. drawaninsulindosefrom TheVAwebsitesaiditshealthcarethepenscartridge.Thatis system now has standardized the pre- dangerous,accordingtothe scribing and dispensing of U-500 insu- ISMP,becausethepractice lin at VA facilities according to ISMPcouldintroduceairintotheIn the critical-care setting, continuous intravenous insulin infusion has guidelines.cartridge or reservoir, leadingbeen shown to be the best method for achieving glycemic targets. Despiteproblemswithhowtheytosubsequentinsulinunder-are used on occasion, the ISMP noteddoses and subcutaneous injection of air.patient is receiving continuous enteral/that,intheinpatientsetting,insulinIt also warned that, improper sharing ofparenteral nutrition is indicated to cor-pens offer some advantages over vialsinsulin pens among multiple patients hasrect hyperglycemia. beyond dosing accuracy, convenience,exposed patients to bloodborne patho- Basal insulin or a basal plus bolus cor-and ease of use: gens, as potentially occurred at the VA. rection insulin regimen is the preferredPens are already labeled by theGuidelinesfromtheAmericantreatment for noncritically ill hospital-manufacturer with the productDiabetesAssociationrecommendedized patients with poor oral intake or name and product bar code; that,outsideofcritical-careunits,those who are taking nothing by mouth,Each pen can be individuallyscheduledinsulinregimensshouldor NPO, while an insulin regimen with labeled with the patients name andbeusedtomanagehyperglycemiainbasal, prandial and correction compo-a patient-specific bar code; patients with diabetes; it added that reg- nents is the preferred treatment for non- The pen provides the patientsimens using insulin analogs and humancritically ill hospitalized patients with insulin in a form ready forinsulin result in similar glycemic con- goodnutritionalintake,accordingto administration;trol in the hospital setting. the guidelines.The ADAexplainedthattheuseofTheADAcitedarandomizedcon- The pen saves nursing time,subcutaneousrapid-orshort-actingtrolledtrialshowingthatbasal-bolus because they are already preparedinsulin before meals or every four totreatmentimprovedglycemiccontrol and easy to administer; andsix hours, if no meals are given or if theandreducedhospitalcomplications Continued on Page 58 u562020 COMPENDIUM OF FEDERAL MEDICINE'