Aim: To assess the quality use and documentation of insulin in a major tertiary hospital and possible reasons for insulin administration errors.
Background: Review of insulin related Riskman data over 6 months showed an average of 6 incidents a month. Types of incidents included withholding insulin inappropriately, missed doses, incorrect dose, patient self administration errors and suboptimal use of the steroid guideline. The Diabetes Education team developed an audit questionnaire to look at contributing factors to insulin incidents.
Methods: The educators developed 11 questions targeting areas of concern regarding insulin use & documentation on the wards. The education team randomly selected inpatients on insulin to audit over a 4 month period, January-May 2012. A further random audit of those not referred to Endocrinology & Diabetes education was also undertaken.
Results: Of those audited 56% had Type 2 diabetes, 16% Type 1 diabetes, 22% Steroid induced and 6% Cystic fibrosis related diabetes. 46% had an HbA1c done pre commencing insulin. 86% did not require dose validation as per the 50/25 rule. 94% of insulin orders were written correctly and with the word “units”. 75% of those audited had the insulin stored and labelled correctly. 58% of the patients were on a sliding scale. 48% of the orders were written by teams other than the Endocrinology team. The majority of patients on insulin were referred to diabetes educators within 3 days of commencing insulin.
Conclusion: Overall it was found that the insulin orders were documented correctly. Human error and educational gaps were probable causes of some Riskman events. Further education of nursing staff will be undertaken. Also to address the self administration errors a sticker of 5 key principles of patient self-administration will be introduced.