Waste of Insulin

[WeirdNurseKelly, BSN, RN]

Hey everyone! I work on a med/surg floor. Most of our patients are post surgical and then we get the overflow of medicine patient. We have a HUGE amount of insulin that is wasted d/t nurses not properly labeling bottles, bottles scattered all around the floor (in COW drawers, med carts, pockets). New bottles are being opened all the time, almost full bottles are being thrown out. About two weeks ago I found a bottle which was probably opened during the day shift (I work nights) that wasn't even labeled!!! So incredibly wasteful.

I am going to work on a little project this year to help us (hopefully hospital wide) cute down on our insulin waste. I am getting a team of a few other nurses together so we are just in the beginning stages. I am trying to brainstorm ideas of how to cut down on the waste. The only thing I can think of is that rather than having bottles opened as a community bottle the bottles be sent up with our patients and designated to just the patient. Some of our patients are only on insulin post op and do not go home on insulin so this wouldn't save on cost BUT the bottles for those who are diabetic would end up taking the bottle home. Does this make sense?

So! I am making this a longer story than needed. I am wondering if some of you nurses could share what you do on your floor with your insulin. I could really use some help with the brainstorming of ideas for this. Something has got to be done. A bottle of aspart is around $100.

I plan on talking with our pharmacy to see how we can track how much we use and how much gets wasted but this may be a difficult task. We may have to do chart audits for our diabetic patients. Like I said. This is just in the beginning stages. I am just now trying to pull a team together for this.

Any help and information would be greatly appreciated.

Thanks!!

[elizabethgrad09]

In my psych hospital, insulin vials are kept in a refrigerator and are withdrawn through a pyxis. Whenever a new vial of insulin is opened, the nurse is supposed to place a label on it with the date that it was opened. These labels are in the refrigerator with the insulin and the label states that the bottle should be discarded after 28 days. Most of the time people remember to put the label on the bottle after opening it.

[SpaceCowgirl, BSN]

Wow, that sounds crazy. At the hospital where I work part-time, each patient had their own insulin pen that stays in their drawer and goes home with them when they're discharged. When it starts to get empty, you call the pharmacy for a refill. At the hospital where I work full-time, we keep vials in the Pyxis and you have to type in the number of units you are taking out for that particular patient, then the computer notifies pharmacy when it's getting low so they can replace the vial.

[MikeyT-c-IV]

we keep vials in the Pyxis and you have to type in the number of units you are taking out for that particular patient, then the computer notifies pharmacy when it's getting low so they can replace the vial.

This is what we do, too. Works great.

[RainMom]

This is what we do, too. Works great.

Same here. There are little stickers in the pocket with the vial that we stick to the syringe so you have a barcode to still scan in the insulin at the bedside. Only issue I've ever really seen is that a lot of nurses won't enter how many units they draw up (the default is "1") so pharmacy often doesn't realize when the bottle is running low & has to be called to refill.

[Nanu09]

I'm not a nurse but I am a type one diabetic of 35 years, and can tell you all that aspart AKA novolog is 263.00 a bottle, and to hear that your coworkers are treating it like trash enrages me as much as you. I don't know **** about how the medical field is run or the rules but I've been uninsured before and struggled to get my insulin. Is there no way that those bottles could possibly be donated to the shelter programs after the one use? So someone in need can have them?

[smf0903]

In my psych hospital, insulin vials are kept in a refrigerator and are withdrawn through a pyxis. Whenever a new vial of insulin is opened, the nurse is supposed to place a label on it with the date that it was opened. These labels are in the refrigerator with the insulin and the label states that the bottle should be discarded after 28 days. Most of the time people remember to put the label on the bottle after opening it.

This is how our hospital does it too. Through the Pyxis we can change the #of units we're going to pull (humalog is our most used insulin and it defaults to 10 units unless you change it). We don't have an issue with wasted insulins. At most we may have two "open" vials of humalog at once and even that's pretty rare.

Our facility would have our butts if we were wasting insulins like that!!

[jodispamodi]

we have individual bottles for each patient that are labelled by pharmacy and kept in locked cabinet in patient's room. If patient starts on another unit, ticu fir example the bottle travels with the patient when they go to step down or regular floor. System is not 100%perfect but close to it.

[Koalified]

This is what we do, too. Works great.

Same here. We ave a computer in the med room to scan the vial into Epic while the pyxis is still open. When you take the syringe into the pt's room, you don't need to scan, just click on the MAR and document given.

[WeirdNurseKelly, BSN, RN]

I know this is super delayed. I haven't been on the site in MONTHS.

Thanks for all of your input.

A couple of things. We keep unopened bottles in a med room in the fridge. In that room there is a chart that helps calculate when to date the bottle AND our labels!!! Some nurses don't label the bottles. We do keep them in a locked drawer near our insulin syringes once the bottles have been opened.

We have non-diabetics who receive insulin post surgically to keep their blood sugars under control to help promote healing and prevent infection. They are on a sliding scale and don't discharge with insulin so it wouldn't be cost effective to keep the insulin in locked boxes for everyone who is on insulin during their hospital stay. I almost wonder if maybe we should send up bottles for those who are on insulin at home and have them go home with the bottle. Keep a very small amount of insulin bottles on the ward for those who are on insulin short term during their stay in the hospital.

I still haven't figured this one out and yet again, just two weeks ago I found another 2 bottles of insulin (aspart being one of them) full and unlabeled. Our supervisors talk about it during morning minute but nothing ever changes :'(

Makes me mad. Hundreds of dollars are being thrown away and it is coming out of our budget. Its not like enough crap gets wasted. I get so mad!!!!

[MunoRN, RN]

While I completely agree with the need to appropriately label and store patient insulin in order to avoid waste, the short and intermediate insulins typically used in the inpatient setting costs hospitals in the range of $20-$30 a vial. There's also the issue of appropriate use of insulin in non-diabetic hospitalized patients, while it used to be commonly accepted practice to administer insulin to these patients to tightly control BG levels, there isn't actually any evidence to support such a broad use of sliding scale insulin in the hospital medical and surgical inpatient populations. There is some proven benefit to moderate control of post-op cardiothoracic surgery patients in the immediate post-operative period.