How do you ensure the right INSULIN pen for the right patient?

  1. Hello fellow nurses!


    I am in the process of reviewing literature on whether double-checking vs. single-checking subQ insulin is improving patient outcomes.


    If you are a nurse who administers subQ insulin via patient-specific insulin pens, could you share on
    what safety checks/processes are REQUIRED at your facility to make sure that you are using the right insulin pen on the right patient?


    For example, at my facility here in Southern California, barcode scanning does not ensure that the pen is for the right patient--only the required double-checking process (with another nurse) does.


    Thank you so much for sharing! Your input will help me think of ways to ensure patient safety when using insulin pens at our hospital.


    KT
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  2. 2 Comments

  3. by   marienm
    The barcodes our pharmacy prints are patient-specific. Can your pharmacy print custom labels? All of our patient-specific antibiotics, most high-alert gtts (even at standard concentrations), and custom IV fluids have these labels. If there happen to be 2 patients on the unit with the same drug, EPIC won't accept the other patient's drug as an acceptable item on your pt's MAR. (I know that not everyone uses EPIC; I assume barcode-reading software is pretty adaptable.)

    Now, I have to admit that we don't actually use insulin pens at my hospital. I think they were too costly--patient is admitted for 3 days, gets 10 units of Lantus every night, pt is discharged, 70 units of Lantus goes to waste. But I still think pt-specific barcodes would work for this issue, as long as they weren't too floppy/wouldn't get too wrinkled when you hold the pen to inject.

    At my hospital all the insulins are drawn from common vials and our Pyxis prints a patient-specific dose-specific (for sliding-scale doses) label. It requires an RN witness on removal to confirm the dose that's being removed. Irritatingly, the Pyxis doesn't interface with the lab results system, so the verifying RN has no idea how much insulin the patient needs based on the sliding scale orders--they're really just verifying that the RN can read a syringe. Barcodes wouldn't solve this problem--if your facility requires that a nurse double-check the dose dialed into the pen, I'm not sure that there's an alternative (other than just eliminating this double-check).
  4. by   KTakami25
    Quote from marienm
    The barcodes our pharmacy prints are patient-specific. Can your pharmacy print custom labels? All of our patient-specific antibiotics, most high-alert gtts (even at standard concentrations), and custom IV fluids have these labels. If there happen to be 2 patients on the unit with the same drug, EPIC won't accept the other patient's drug as an acceptable item on your pt's MAR. (I know that not everyone uses EPIC; I assume barcode-reading software is pretty adaptable.)

    Now, I have to admit that we don't actually use insulin pens at my hospital. I think they were too costly--patient is admitted for 3 days, gets 10 units of Lantus every night, pt is discharged, 70 units of Lantus goes to waste. But I still think pt-specific barcodes would work for this issue, as long as they weren't too floppy/wouldn't get too wrinkled when you hold the pen to inject.

    At my hospital all the insulins are drawn from common vials and our Pyxis prints a patient-specific dose-specific (for sliding-scale doses) label. It requires an RN witness on removal to confirm the dose that's being removed. Irritatingly, the Pyxis doesn't interface with the lab results system, so the verifying RN has no idea how much insulin the patient needs based on the sliding scale orders--they're really just verifying that the RN can read a syringe. Barcodes wouldn't solve this problem--if your facility requires that a nurse double-check the dose dialed into the pen, I'm not sure that there's an alternative (other than just eliminating this double-check).
    Hi marienm, RN!

    Thank you so much for replying with very helpful specific details! My hospital is transitioning over to EPIC next year from Allscripts SCM and I am wondering if we would have patient-specific pharmacy prints for our insulin pens, too, by then (but we currently stock ours in Pyxis).

    Also, thank you for describing to me your hospital's Pyxis system setup and RN double-check process that goes with it. I appreciate your insight!

    Sincerely,
    KTakami25

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