Using our advice
This resource supports healthcare professionals (HCPs) in taking actions to promote the safer use of insulin. It aims to equip HCPs with insights, support, and shared learning, to address practice with insulin that may lead to harm.
Patient harm
Harms associated with insulin use remain a result of some of the most commonly reported errors across healthcare settings. They can significantly impact people’s health and experiences of using healthcare.
Safety directives
A number of safety directives have been issued to address known insulin safety risks.
The NHS England ‘enduring standard’ for the safe administration of insulin states insulin doses should be administered from an insulin syringe or pen device.
The NHS ‘Never Events list’ includes ‘overdose of insulin due to abbreviations or incorrect device’.
There are a number of MHRA safety alerts relating to insulin.
Organisations should review current practice against these directives to help prioritise safety initiatives.
Clinical use
Several NICE guidelines relate to the use of insulin in different patient groups.
The Joint British Diabetes Societies for Inpatient Care Group has guidance supporting the safer use of insulin.
Key strategies to improve insulin safety
Individuals using insulin are cared for in all health settings, and engage with a range of HCPs. Insulin prescribing is prevalent across all sectors, affecting a wide range of people. A system-wide approach is needed to support the safer use of insulin.
Given the scale of the challenges with insulin safety, it may be useful to prioritise or focus on specific populations or settings when taking initial steps to address the issue. Several strategies can be used to improve insulin safety. These may be used alone, or in combination with one another.
Professional collaboration
A collaborative approach is needed to support the safer use of insulin. A range of HCPs in different care settings interact with individuals using insulin so should therefore be involved with insulin safety initiatives.
Creating a core working group, including key stakeholders from across the system and a range of professional groups, supports a coordinated approach to improvement. Nominating a leadership team, with defined responsibilities, provides necessary oversight.
The presentation at time 16:46 of the webinar (at the end of this article) discusses a collaborative, system-wide quality improvement project to improve insulin safety by learning from harms. The webinar video is included at the end of this article.
Learning from incidents
HCPs should learn, and share learning, from medication incidents.
NHS England’s Learn from Patient Safety Events (LFPSE) service is a national system for recording and analysing patient safety events.
NHS England’s Patient Safety Incident Response Framework (PSIRF) sets out the NHS’s approach to developing and maintaining effectives systems for responding to safety incidents. The Specialist Pharmacy Service have medication safety resources which offer practical support.
The presentation at time 1:08:17 of the webinar (at the end of this article) discusses an example of a staff-education programme implemented in response to an insulin medication incident.
These 5-minute videos from SPS and the MHRA discuss Yellow Card reporting, and how HCPs can help encourage diabetes device users to report concerns with any of their diabetes devices.
Patient engagement and education
Understanding the lived experience of individuals using insulin can help HCPs better understand the complexities around insulin safety that impact them. This understanding can be used when designing and implementing interventions to improve safety.
The conversation at time 04:43 of the webinar (at the end of this article) explores an individual’s experiences of being a hospital inpatient with diabetes.
This 18-minute podcast explores an individual’s experience of living with diabetes and visual impairment. It discusses some of the challenges of managing insulin alongside visual impairment.
Several organisations have resources to help individuals using insulin:
- Trend Diabetes leaflets for people living with diabetes
- Diabetes UK education and information materials, these are available in a range of languages and easy-read formats
- the Diabetes UK Learning Zone provides advice and support to individuals using insulin
Consider using or signposting to these resources when developing and delivering safety initiatives.
Communication at the care interface
Insulin is supplied and administered in different care settings across the system. Clear communication between these settings (for example of insulin dose, formulation and device changes) can help support the safer use of insulin. Clear policies can facilitate effective communication at the care interface.
Patient-held information
This 20-minute podcast discusses using patient engagement and patient-held information to support the documentation and communication of essential information at transfers of care.
Utilising electronic systems
Where available, electronic prescribing and medicines administration (EPMA) systems may help to reduce medication errors. EPMA systems can alert HCPs to issues, for example unusual or incorrect dosing.
However, EPMA systems and their functionality vary widely between organisations and require local review and configuration.
ePRaSE is an online tool to help hospitals evaluate their EPMA systems. It aims to support optimisation and improve safety.
Upskilling healthcare professionals
HCPs involved in prescribing, supplying or the administration of insulin should be equipped with the skills to promote the safer use of insulin.
Several organisations offer resources and guidance for HCPs caring for individuals using insulin:
- NHS England’s e-learning for healthcare Safe Use of Insulin programme supports the safe prescribing and administration of insulin
- NHS England’s Getting It Right First Time Diabetes Academy Resources provide best-practice resources
- The Trend Diabetes Learning Hub includes e-learning, educational videos and podcasts
- Diabetes on the net’s free CPD module on the Six Steps to Insulin Safety
- Cambridge Diabetes Education Programme provides bite-sized online diabetes training
- EDEN resources provide guidance and practical tools
HCPs should review opportunities to utilise these resources where appropriate.
Awareness of insulin products and formulations
There are a range of insulin products available, including high strength formulations, fixed combination products and biosimilars. Confusion between these products can lead to errors and harm.
Self-management of insulin
Individuals usually self-manage their insulin use at home, and should be offered the opportunity to continue to self-manage whilst in inpatient settings. This can help to empower individuals to manage their insulin as they normally would, including linking administration to mealtimes.
The presentation at time 1:19:20 of the webinar (at the end of this article) discusses the importance of insulin self-management for hospital inpatients.
The SPS series of articles about the self-administration of medicines includes practical support. The presentation at time 52:44 of the webinar explores the process for implementing inpatient self-management of insulin at an acute Trust.
This 14-minute podcast discusses some of the challenges and considerations for insulin safety in health and justice and secure settings, including the self-management of insulin.
Organisations should review opportunities to increase self-management of insulin to promote safer use.
Standardised practice
Where possible, roles and responsibilities should be clear and understood across the system.
Clear policies and guidelines help to outline good practice, and may help reduce insulin-related medicines incidents.
The presentation at time 36:18 of the webinar (at the end of this article) discusses an example of how local policies have been developed and implemented to support insulin safety.
Introducing an intervention
Before implementing an intervention, it is useful to identify where it sits within the already-established system. Any possible unintended consequences that may arise as a result of the intervention should also be considered.
Prior to implementing an intervention, decide which outcomes will be measured. This will support the analysis of the effectiveness of the intervention.
Shared good practice
Sharing experiences with improvement interventions can help to prevent duplication, support efficient use of resources and promote standardised practice across the NHS. Examples of exemplar practice, and a discussion board to network with peers, can be found on the MSATS FutureNHS workspace.
Full webinar recording
The SPS Medication Safety across the System series of webinars are interactive sessions aimed at HCPs working in any sector with a role within or passion for medication safety.
The recording of the full MSATS: Insulin safety webinar is available. Information presented during the webinar and associated videos was correct at time of recording. Current guidance should be followed.