Safe use of insulin

• Insulin must be prescribed correctly
• Obtain an accurate history for all patients on insulin. Medicines reconciliation is key.
• Prescriptions for insulin should be prescribed on HEPMA by brand name including the correct prescribed strength, the patient’s usual delivery device where appropriate, the dose and the timing of the dose(s).
• If patient is on variable insulin dose this should be prescribed on HEPMA as ‘INSULIN Variable Rate Intravenous Infusion AS PER CHART’ and the supplementary chart kept within the treatment room and be available at the time of administration whilst in use then filed in case notes when no longer in use.

• Insulin preparations should be labelled for individual patients
• Labels should contain the patient name and CHI number
• Put the date opened on insulin preparations when they are first used.

To maintain efficacy, insulin preparations must be stored correctly. The product literature with each product will detail the storage requirements. The following general points apply

• Prior to first use store all insulin preparations in a refrigerator.
• Store a room temperature while in use.
• Do not keep non-disposable pens in a refrigerator as the plastics and mechanism may be damaged by temperature changes.
• Only use patient's own insulin supplies if you are sure they've been stored correctly prior to admission.
• All in-use insulin pens should be stored in a segregated area of the drug trolley or patients medicine locker.
• Insulin must be discarded one month after first use.

There are a wide variety of insulin preparations and devices available. Where insulin is in use staff administering it must understand the type of preparation being used (short, medium or long acting) and know how to correctly operate the relevant delivery device.

The following general principles should be followed.

• Blood glucose monitoring should always be performed before administering insulin. Guidance can be found here.
• Only administer insulin if the prescription is clear and unambiguous.
• Check that the preparation name and device match those on the prescription.
• Check that the patient's name and CHI number on the device match those on the prescription. Check the patient's ID too.
• Select the dose correctly and have it checked by a second nurse prior to administration.
• Two practitioners must witness all aspects of the administration process i.e. preparation selection, drawing
  up the dose and the administration of the dose.
• If the dose is being drawn up from a vial only use insulin syringes designed for that purpose.
• Patients may only self-administer as part of a formal self-medication programme but the nurse must check all relevant parameters before the patient administers the insulin.

For more detailed information on the administration and use of insulin, the e-learning package Diabetes Think Check Act (5 modules) is available via learnPro