b'Insulin Errors Potentially Plague Hospitals Treating Diabetes Patientsu From Page 56compared with sliding scale insulin in generalsurgerypatientswithType2CDC Guidelines on Institutional Use of Insulin Pensdiabetes and strongly urged against soleThe national Centers for Disease Control and Prevention recommends use of prolonged sliding scale insulin inthe following to make sure patients are not put at risk for infection the inpatient hospital setting.through use of an insulin pen.i nTravenousi nsulin RecommendationsIn the critical-care setting, according to Insulin pens containing multiple doses of insulin are meant for use the guidelines, continuous intravenouson a single person only and should never be used for more than one insulin infusion has been shown to beperson, even when the needle is changed.the best method for achieving glycemic Insulin pens should be clearly labeled with the persons name or targets.Intravenousinsulininfusionsother identifying information to ensure that the correct pen is used should be administered based on vali- only on the correct individual.dated written or computerized protocols that allow for predefined adjustments in Hospitals and other facilities should review their policies and the infusion rate, accounting for glyce- educate their staff regarding safe use of insulin pens and similar mic fluctuations and insulin dose. devices.Anothersetofissuesoccurswith If reuse is identified, exposed persons should be promptly notified intravenousinsulinadministration,and offered appropriate follow-up including bloodborne pathogen however. A 2014 ISMP survey of phar- testing.macists and nurses found that intrave-nousinsulinrankedfirst,andsubcu-taneousinsulinrankedninthamongLastsummer,theFoodandDrugfaster delivery to patients, streamlined nearly 40 drugs and drug classes identi- Administration approved the first andworkflowforpharmacistsandnurses, fied as high-alert medications that con- only ready-to-use insulin for IV infu- and less waste for hospitals.cerned practitioners. sion.Theproduct,Myxredlin(InsulinMyxredlin, for use only in acute care ISMPhasurgedthatverbalordersHumanin0.9%SodiumChloridesettingsundermedicalsupervision, should not be accepted for IV insulin,Injection)hasanextendedshelflifeisindicatedforuseasashort-acting preferringthattheordersshouldbeof 30 days at room temperature (77humaninsulintoimproveglycemic faxxed or otherwise transmitted whenF [25C]) or 24 months if refrigeratedcontrol in adults and pediatric patients theprescriberisoff-site.Ifnoother(36 F to 46 F [2 C to 8 C]) in thewith diabetes mellitus.alternative exists, emergency telephoneoriginal carton to protect from light. 1Anderson TS, Lee S, Jing B, et al. Prevalence orders should be accepted with a sec- It is provided in a standardized con- of Diabetes Medication Intensifications in ondpersonlistening,transcribingthecentrationof100units/100mLinaOlder Adults Discharged From US Veterans order directly onto an order form andflexible plastic container. Health Administration Hospitals. JAMA Netw Open. 2020;3(3):e201511. doi:10.1001/jama-repeating it back for clarification. It alsoInsulin is in the top five drug classesnetworkopen.2020.1511.urged that all insulin infusions be pre- involvedwithmedicationerrors,and2Lutz-McCain SJ, Bandi A, Larson M. Advanc-pared in the pharmacy and emphasizedmorethan30%ofthoseerrorsresulting Patient Safety and Access to Concentrated that insulin must never be dispensed orinpatientharm,pointedoutRobertInsulin (U-500 Regular Insulin) in the Veterans administeredwithoutanindependentFelicelli,president,pharmaceuticals,Health Administration: A Clinician Education Program in the Primary Care Setting. Clinical check, using the actual order and veri- Baxter. When a patient requires intra- Diabetes: a Publication of the American Diabe-fying that the patient needs insulin orvenousinsulininthehospital,phar- tes Association. 2018 Jul;36(3):244-250. DOI: has hyperglycemia.macists have to manually admix insu- 10.2337/cd17-0033.ApossiblesolutiontoavoidingIVlinfortreatment.Withthelaunchof3American Diabetes Association. 15. Diabetes errors is using products that are alreadyMyxredlin, clinicians will have accessCare in the Hospital: Standards of Medi-cal Care in Diabetes-2019. Diabetes Care. preparedforIVinfusioninhospitalsto a convenient, reliable presentation of2019;42(Suppl 1):S173S181. doi:10.2337/and other acute-care settings. ready-to-use insulin that can help ensuredc19-S015.582020 COMPENDIUM OF FEDERAL MEDICINE'