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Embedding the safer use of insulin 

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Implementation of national safety standards, alerts and guidance can help reduce preventable harm from insulin use.

This article forms part of a series
  1. Embedding the safer use of insulin 
    1. Managing the risk of confusion between insulin products
    2. Safety considerations when switching insulin products
    3. Developing insulin safety across a system

Contents

  1. Clinical use
  2. Patient harm
  3. Safety directives
    1. Never Events
    2. Enduring standards
    3. MHRA
    4. Organisational assurance
  5. Supporting guidance
    1. Handling insulin
    2. Prescribing by brand name
    3. Time critical medicines
  7. Learning from harm
  8. Acknowledgments

Clinical use

Individuals using insulin are cared for in all health settings and engage with a range of healthcare professionals. 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.

Several NICE guidelines relate to the use of insulin.

The Joint British Diabetes Societies for Inpatient Care Group has guidance supporting the safer use of insulin.

There is a wide range of insulin preparations available with differing product characteristics.

These articles focus on safety standards and improvement initiatives which promote the safer use of insulin.

Patient harm

Harms associated with insulin use remain some of the most commonly reported errors across healthcare settings. They can significantly impact people’s health and experiences of using healthcare.

Examples of harm include:

  • misinterpretation of insulin strength (expressed as units/mL) as the prescribed dose (in units), resulting in significant underdosing or overdosing
  • using abbreviations such as ‘U’ or ‘IU’ for ‘units’ can lead to misreading of letters as numbers, resulting in tenfold or greater dosing
  • withdrawing insulin from pen devices or cartridges using a syringe, which increases the number of manipulations, leading to dosing errors
  • incorrect adjustment of the prescribed number of units when switching between insulin strengths or products.

Safety directives

Several safety directives have been issued to address known insulin safety risks.

Organisations should regularly review local processes and practice to ensure that the standards outlined in the directives below are systematically embedded and support safety improvement priorities.

Never Events

Never Events are defined as serious incidents that are wholly preventable because national guidance or safety recommendations provide strong systemic protective barriers. It is expected that these should have been implemented by all healthcare providers.

The NHS ‘Never Events list’ and ‘recommendations from historical National Patient Safety Agency alerts that remain relevant to Never Events’ provide supporting guidance that outline considerations that organisations should ensure are embedded in clinical practice, to prevent Never Events relating to insulin use.

Enduring standards

NHS England’s enduring medication safety standards are content and actions from previous patient safety alerts that remain valid and relevant.

MHRA

There are a number of MHRA safety alerts relating to insulin.

Organisational assurance

Organisational assurance that local processes and practice align with safety directives helps to mitigate known risks.  Assurance may include local audits, inspections or gap analysis using standards from historic national patient safety alerts that remain relevant to Never Events or enduring standards. These include:

  • when prescribing insulin, the term ‘units’ is used in all contexts; abbreviations such as U or IU are never used
  • all regular and single insulin (bolus) doses are measured and administered using a commercial insulin pen device or an insulin syringe
  • an insulin syringe must always be used to measure and prepare insulin for insulin infusion.

Supporting guidance

Additional guidance from SPS can be used to inform standards or the design of medicines-related processes.

Handling insulin

Our guidance on Preventing errors on the medicine journey (SPS page) provides guidance on the safer use of medicines through review and strengthening of medicines-related processes.

Our guidance on Multiple Use of Injectable Medicines in Clinical Areas (SPS page) supports organisations with the development of safe practices related to the handling of insulin.

Prescribing by brand name

Our guidance on Example medicines to prescribe by brand name (SPS page) recommends that insulin is prescribed by brand name.

Time critical medicines

Insulin is a time critical medicine and delays can lead to severe patient harm. Our guidance Understanding time critical medicines to support improvement (SPS page) helps to support improvement work in this area.

Learning from harm

The Health Services Safety Investigation Body (HSSIB) has published several patient safety investigations involving insulin, which provide valuable learning for reducing the risk of patient harm.

Acknowledgments

This article series content was developed using insights from our SPS Medication Safety Across The System (MSATS): Safer Use of Insulin webinar event and the expertise of Claire Davies, Diabetes and Endocrinology Specialist Pharmacist, who supported this work during a recent short-term secondment with the NHS SPS Medicines Use and Safety team.