Insulin is considered one of the ‘high risk medications’ which, if used in error, can cause catastrophic harm. There are national recommendations for safe abbreviations to reduce risk of insulin errors (1). Identification of inappropriate insulin prescribing and documentation and a subsequent education program highlighting these instances may help to improve the safety of insulin administration.
To evaluate insulin prescribing and documentation, identify areas of risk and use this information to develop an organisation-wide, multidisciplinary insulin safety strategy.
An audit of all inpatient medication charts was conducted on a single day. It was repeated every six months two years. Where an insulin prescription was identified, all documentation relating to insulin for that patient was evaluated, including insulin name, abbreviations, administration instructions and telephone orders documented by nurses.
Whilst results over 2 years remain mixed, the following changes have already being introduced:
a) Diabetes education sessions attended by junior doctors, nurses and medical students include a focus on insulin safety
b) Insulin is now promoted as one of the high risk medications in the bi-monthly Medication Safety Newsletter
c) Organisational policy for use of abbreviations has recently been altered to incorporate guidelines of the National Recommendations for Terminology, Abbreviations and Symbols used in the Prescribing and Administration of Medicines.
Routine auditing of insulin prescribing identified several high risk issues in our organisation. Change has been slow to implement, but evidence of risk has been a powerful tool to encourage quality improvement. Key areas for ongoing education are junior doctors to ensure prescribing is clear and unambiguous, senior doctors to raise the relevance of safe prescribing, and nurses to eliminate use of dangerous abbreviations in telephone orders.