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

[KTakami25]

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

[marienm, RN, CCRN]

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).

[KTakami25]

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

[RosesrReder, BSN, MSN, RN]

They have patient specific barcodes with their pt info. They're also locked and kept inside the pt's room not in a bin in a med room.

[KTakami25]

They have patient specific barcodes with their pt info. They're also locked and kept inside the pt's room not in a bin in a med room.

Hi Jessy_RN,

Thank you so much for your insight! That's great to hear that there is a hospital somewhere that does have patient-specific barcodes on single-use insulin pens! That is so interesting to hear that they are also locked in the pt's room instead of in a med room.

Because I am thinking of eventually proposing a workflow like this at my hospital (we are currently busy with transitioning to a different EHR), would you mind telling me what organization/hospital you work at? If this is too personal, would you mind telling me what state you are from? This info will help me in substantiating my proposal and possibly allow me to find out from your organization about the workflow. If not, that is ok, too. You letting me know this workflow exists is very helpful already!

Thank you so much!

[liluiass]

we don't use lot of insulin pens but when we do

I do it the old fashioned way : I write down the patient's chamber number and his name on a little sticker that I put on the vial and that's enough for me

I've never administered the wrong type of insulin to anyone...maybe I made mistakes with the dosage but not the type of insulin...

[KTakami25]

we don't use lot of insulin pens but when we do

I do it the old fashioned way : I write down the patient's chamber number and his name on a little sticker that I put on the vial and that's enough for me

I've never administered the wrong type of insulin to anyone...maybe I made mistakes with the dosage but not the type of insulin...

Thank you for your input! :)

[Here.I.Stand, BSN, RN]

Ours are sent with a pharmacy label affixed to the pen -- same as a pre-mixed bag of antibiotics or hypertonic saline do.

[Cat365]

I don't work on the floor in my current hospital so I can't really tell you what they do here, but at a previous one the pens were kept in the patient room in a passcoded bin. I don't think that hospital had the capability to make an individual barcode ( their charting system definitely needed help). The biggest issue that they had was when the bins were not emptied between patients. I would occasionally go around checking the bins in all empty rooms (as a night tech) and find meds from multiple patients in a single bin. Individual barcodes would have been a great safety feature.

[KTakami25]

Ours are sent with a pharmacy label affixed to the pen -- same as a pre-mixed bag of antibiotics or hypertonic saline do.

Hi Here.I.Stand, BSN, RN,

Thank you for your input! :)

[KTakami25]

I don't work on the floor in my current hospital so I can't really tell you what they do here, but at a previous one the pens were kept in the patient room in a passcoded bin. I don't think that hospital had the capability to make an individual barcode ( their charting system definitely needed help). The biggest issue that they had was when the bins were not emptied between patients. I would occasionally go around checking the bins in all empty rooms (as a night tech) and find meds from multiple patients in a single bin. Individual barcodes would have been a great safety feature.

Hi Cat365, I agree with you that individual barcodes would be a great safety feature. Thank you so much for your input!

[areason4stars, ASN, RN]

At my facility which is a residential psych facility for children and teens we have a few diabetics and they all have their own pens. We keep the current pen(s) in a pencil box like this see image below . With one of the clients labels on the box along with the client's ordered insulin formula and ordered long acting insulin orders typed up and taped over on the box. In the box we also keep a few of the needle caps in the box as well. Their name will also be written with sharpie on the box. on the pen itself sometimes there will be on of their sticker/labels wrapped around the removable cap part of the pen and/or initials written on the cap. These are kept in the med room on the unit the particular client is on. ( this would be a pia system on a larger scale tho and with shorter average stays)