Multi-disciplinary teaching improves insulin prescribing

Francesca M Conway, FY2, North West Thames

Background: Maladministration of insulin features in the UK Department of Health’s “never events”, and is frequently included in the top 10 “high alert” medications worldwide, highlighting its potential to cause serious harm. A rapid response report was issued in 2010 to advocate safer use of insulin, however the National Diabetes Audit in 2012 demonstrates that prescribing problems remain prevalent.

Objectives: To assess compliance of insulin prescriptions against Patient Safety First insulin prescribing standards, based on National Patient Safety Agency guidelines, and to make recommendations to improve insulin prescribing with the aim of enhancing patient safety.

Methods: Insulin prescribing was reviewed during a one-day cross-sectional audit on 16 October 2013 at Central Middlesex Hospital. All drug charts on all wards containing an insulin prescription were included. ITU prescriptions were excluded. Prescriptions were assessed against the following standards with targets as below:

a)    100% of prescriptions to include brand and word “insulin”

b)    100% of prescriptions to include word “Units” written in full (or omitted completely)

c)    100% of prescriptions to be signed and dated

d)    100% of prescribers to specify insulin device

Results:  23 prescriptions were included. 100% of insulin prescriptions were unambiguous in “units” prescription. 9% of prescriptions lacked a signature and 26% lacked a date. 17% of prescribers specified a device.  9% included the brand and word “insulin.” Other errors noted were incomplete insulin names, with 25% of humulin prescriptions not documenting type.  Recommendations: Multi-disciplinary educational strategies including teaching from pharmacists, diabetes specialist nurses and different levels of doctors took place to improve understanding of insulin use and prescribing. Recommendation made to re-audit in 3 months. 

Re-audit: Re-audit was carried out on 20 January 2014 in accordance with the above methods. It demonstrated improved compliance with standards, with 94% of prescriptions being signed and 94% dated. The prescription of “units” remained 100% compliant. Device prescription improved but remained suboptimal at 41%. 100% of prescriptions contained a complete insulin name, including humulin prescriptions. 

Conclusions: Education from a variety of MDT members improves insulin prescribing.