Misuse of insulin pens and patient safety

[PACURN1956]

I work in a 700+ bed hospital that has been using insulin pens for several years. It has been recently announced that the pens will be discontinued because of rampant misuse of the pens by the nursing staff. I was mortified to learn that pharmacy was able to track one pen being used on over 100 patients. I work in a unit (PACU) where we still draw up insulin from a multiuse vial. I could not believe that this is occuring so frequently and apparently by the same nurses over and over again. I do not know if the patients involved are being informed but I do know that the nurses involved are still working. When I voiced my shock I was told that this error is occuring in hospitals everywhere. Am I crazy in thinking that every nurse should know this is unsafe and immoral, dare I say criminal behavior? Now I am being told that mass education will be needed for the switch back to multidose vials because nurses don't know how to draw up insulin, some have been caught using 3ml syringes. What is going on? It has been many years since I was in nursing school but geez this is kind of basic stuff. If nurses are so careless about something as basic as this, what is going on with more complicated skills? I am interested to hear from hos

[lmccrn62, MSN, RN]

It happened where I came from and they got rid of them except in a few select areas. Gross! My guessing staff just did not understand the use of the pen.

[texasmum]

Can't draw up insulin? Isn't that taught in the first 15 minutes of nursing school? :)

[LadyFree28, BSN, LPN, RN]

Whenever I have used the insulin pen in the facilities I have worked for, no issues; if anything, more accuracy in administering insulin :).

My concern is that there has been corrective action in the past, yet the nurses have not improved; is there some disconnect that keeps on happening that has not been covered in the reviews of insulin pens??? I fear it will be WORSE regarding drawing up vial insulin...

[MN-Nurse, ASN, RN]

I work in a 700+ bed hospital that has been using insulin pens for several years. It has been recently announced that the pens will be discontinued because of rampant misuse of the pens by the nursing staff. I was mortified to learn that pharmacy was able to track one pen being used on over 100 patients.

I've heard of these horror stories and have some idea why the misuse of pens would occur. My hospital pharmacy is fairly bad at getting medications to the floors in a timely matter.

Except when it comes to insulin pens. When we first got the pens, pharmacy took their usual sweet time getting them to us. So we used the few remaining multi-use vials we had on hand during the switchover to pens (with the correct needles, for pete's sake). However, we had to override the barcode scanner on the MAR because we were not using the prescribed pen.

Multiple insulin MAR overrides got sent up the chain and management began bellowing, "WHY AREN'T YOU USING THE PENS?!?!?!"

"Because we don't have them. Pharmacy takes hours to send them - or just doesn't send them at all - and patients need the freaking insulin."

Someone then shook pharmacy's tree. Hard. New insulin pen orders now arrive in a timely fashion. If a pen is empty or lost - it replaced very quickly on request.

I can easily imagine a scenario where another facility would remove the vials and insulin syringes and decree "Pen only" - and then NOT supply the pens needed. This would force the staff to either not give any insulin or use the same pen for different patients. The pharmacy department loves it because they don't have to fill orders, the purchasing department loves it because they buy fewer pens. The staff hates it, but they feel they have no other choice. Management (the source of the entire problem) looks the other way - until they get found out.

Then when the kimchee hits the fan they do what management weenies do best - they blame the nurses and "remove" the pens. Pens that were not used properly because management, again, didn't do their freaking jobs.

[SuzieVN]

Aren't insulin pens prescribed to a single patient? Is there any way to know if they are at least changing the needles between patients?

In LTC, I've been at a couple places that required every insulin draw to be witnessed'signed off by two nurses, there were so many med errors.

[Sun0408, ASN, RN]

Wow, 3ml syringe for insulin.. That is scary. We used the pens at my last facility. I miss them, however, I found many nurses not priming the needle with 1-2 units insulin before dialing up the ordered dose. Package insert states to do that but many didn't know until I brought it up.

[Hygiene Queen]

I was wondering why the heck our Pyxis had a sign on it about not using the insulin pens for more than one pt!

I was like, "what the heck?" and was wondering if something happened at my hospital.

We have to pull a new pen just like any other med-- that is, it's pulled under the pt's name-- so one would have to wonder if someone on insulin never had that pen pulled.

Once it's pulled, though, it's labeled with the pt's name and in the bulk drawer... and so it's has their name on it (!) so why on earth someone would just use it for someone else is beyond me. That's nasty.

@ Suzie: the needles for the pens are only good for one shot... at least ours are (maybe somewhere else it's different, I don't know) so once it's shot, it's done and you have to get a new needle.

Every time, before the new needle is screwed on, we wipe the pen with alcohol. We prime it, waste it, shake off the excess and check it between two nurses... and that includes checking to make sure the name on the label matches the name on the MAR. I've never caught a wrong pen for the wrong pt.

Using the same pen for multiple pt is just laziness! How can one not know that is wrong?

And the pen is so easy, too! It would be a shame if we lost them because someone was being an idiot.

And like someone already said, if these folks are negligent with a pen, what can we expect with a vial?

[Morainey, BSN, RN]

You mean, use the same pen on multiple patients?? Innnnteresting.

Side note, we started learning about insulin before the nursing program - in dosage calculation we learned about which order to draw up insulin in, and how many units, etc etc etc.

[SuzieVN]

Can you enlighten me- is it possible to aspirate blood into the pen? And if so...using it on more than one patient? Well, I was going to ask, but just found the answer:

Ongoing concern about insulin pen reuse shows hospitals need to consider transitioning away from the

[salvadordolly]

All I can say is HOLY CRAP! With nurses like that, I'd be really scared to be a patient!

[ktliz]

lol... when I was taught as a student to use an insulin pen, I was told to squirt a little bit out but I thought it was just to make sure it works (hate not being able to see the insulin actually being administered). Priming the needle make sense, though!

We draw up our insulin from multi-use vials where I work. I'm pretty certain you could teach an intelligent primate to use an insulin pen OR draw from a vial. If there are problems with insulin administration, I would blame the system and not the nurse, e.g. pens not being labeled with patient's name. Administering the insulin is not rocket science. The most difficult part is making sure you know what dose to give.