Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

Abstract

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2023

“…For people taking insulin, several reports indicate that inpatient use of insulin pens is safe and may be associated with improved nurse satisfaction compared with the use of insulin vials and syringes with safety protocols in place (66)(67)(68). Insulin pens have been the subject of an FDA warning because of potential blood-borne diseases if inadvertently shared with more than one person; the warning "For single patient use only" should be rigorously followed using strict safety measures such as barcoding to prevent errors (69,70). Outside of critical care units, scheduled insulin orders are recommended to manage hyperglycemia in people with diabetes.…”

Review of Medication Error Sources Associated With Inpatient Subcutaneous Insulin: Recommendations for Safe and Cost-Effective Dispensing Practices

“…However, patient-specific pens are more expensive than stocking vials, are prone to duplicate dispensing, have the potential for premature needle withdrawal leading to underdosing, and must be primed prior to first administration, leading to waste. [23][24][25][26][27] In a survey of 474 inpatient institutions, 30% (142) reported inadvertently using insulin pens on multiple patients despite CDC recommendation that insulin pens be patient-specific. 28,29 Comparatively, single-use, patient-specific syringes are prepared in a sterile environment and verified in the pharmacy to ensure product and dose accuracy.…”