Strategies to reduce insulin prescribing errors in UK hospitals: results from a national survey

Bain, Amie; Hasan, Syed Shahzad; Kavanagh, Sallianne; Babar, Zaheer‐Ud‐Din

doi:10.1111/dme.14209

Cited by 9 publications

(16 citation statements)

References 22 publications

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“…Our data illustrates the variation between different prescribing systems, including the configuration of medicines within these systems. This is consistent with other research that has shown that there is currently a wide variation within UK hospitals in the functionality of both electronic prescribing and paper-based systems, to enable the safe prescribing of insulin [30].…”

Section: Variations Between Electronic Prescribing Systemssupporting

confidence: 91%

“…Paper prescribing systems inherently lead to variability in prescribing as the prescriber has the freedom of where on the prescription chart the insulin is prescribed-which may in some cases mean bypassing any pre-printed insulin sections. While our findings suggest that this was not the case, it is important to note that not all hospitals who use paper prescription charts have a dedicated inpatient subcutaneous insulin chart [30].…”

Section: Key Findingsmentioning

confidence: 58%

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A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Setra

Jani

2021

Pharmacy

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Accurate and complete prescriptions of insulin are crucial to prevent medication errors from occurring. Two core components for safe insulin prescriptions are the word ‘units’ being written in full for the dose, and clear documentation of the insulin device alongside the name. A retrospective review of annual audit data was conducted for insulin prescriptions to assess the impact of changes to the prescribing system within a secondary care setting, at five time points over a period of 7 years (2014 to 2020). The review points were based on when changes were made, from standardized paper charts with a dedicated section for insulin prescribing, to a standalone hospital wide electronic prescribing and medicines administration (ePMA) system, and finally an integrated electronic health record system (EHRS). The measured outcomes were compliance with recommended standards for documentation of ‘units’ in full, and inclusion of the insulin device as part of the prescription. Overall, an improvement was seen in both outcomes of interest. Device documentation improved incrementally with each system change—34% for paper charts, 23%–56% for standalone ePMA, and 100% for ePMA integrated within EHRS. Findings highlight that differences in ePMA systems may have varying impact on safe prescribing practices.

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Section: Variations Between Electronic Prescribing Systemssupporting

confidence: 91%

Section: Key Findingsmentioning

confidence: 58%

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Setra

Jani

2021

Pharmacy

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“…Additionally, pharmacists should be involved in the insulin prescription process when possible to review charts and to indicate any concerns to physicians and nurses to improve insulin error reduction strategies. [28][29][30] Documentation errors for insulin management were rare in both groups and remained lower than the average error rate reported in a recent NaDIA report. 14 The number of good diabetes days, an indicator for established glycaemic control without the occurrence of hypoglycaemia, remained at a higher level compared with the benchmark of insulin treated patients in the NaDIA audit.…”

Section: Discussionmentioning

confidence: 79%

Evaluation of an implemented new insulin chart to improve quality and safety of diabetes care in a large university hospital: a follow-up study

et al. 2021

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ObjectivesTo evaluate structure, documentation, treatment quality of a new implemented standardised insulin chart in adult medical inpatient wards at a university hospital.DesignA before–after study (3 to 5 months after implementation) was used to compare the quality of old versus new insulin charts.SettingUniversity Hospital Graz, Austria.ParticipantsHealthcare professionals (n=237) were questioned regarding structure quality of blank insulin charts.InterventionsA new standardised insulin chart was implemented and healthcare professionals were trained regarding features of this chart. Data from insulinised inpatients were evaluated regarding documentation and treatment quality of filled-in insulin charts (n=108 old insulin charts vs n=100 new insulin charts).Main outcomes and measuresThe primary endpoint was documentation error for insulin administration.ResultsHealthcare professionals reported an improved structure quality of the new insulin chart with a Likert type response scale increase in all nine items. Documentation errors for insulin administration (primary endpoint) occurred more often on old than new insulin charts (77% vs 5%, p<0.001). Documentation errors for insulin prescription were more frequent on old insulin charts (100% vs 42%) whereas documentation errors for insulin management rarely occurred in any group (10% vs 8%). Patients of both chart evaluation groups (age: 71±11 vs 71±12 years, 47% vs 42% women, 75% vs 87% type 2 diabetes for old vs new charts, respectively) had a mean of 4±2 good diabetes days. Overall, 26 vs 18 hypoglycaemic episodes (blood glucose (BG) <4.0 mmol/L (72 mg/dL), p=0.28), including 7 vs 2 severe hypoglycaemic episodes (BG <3.0 mmol/L (54 mg/dL), p=0.17) were documented on old versus new insulin charts.ConclusionsThe implementation of a structured documentation form together with training measures for healthcare professionals led to less documentation errors and safe management of glycaemic control in hospitalised patients in a short time follow-up. A rollout at further medical wards is recommended, and sustainability in the long-term has to be demonstrated.

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“…prescribing practice and intervention use across all National Health Service (NHS) hospital trusts in the UK [8]. The entire population of NHS hospital trusts was chosen as the sample.…”

Section: Use Of the Questionnairementioning

confidence: 99%

Use and validation of a survey tool to measure the perceived effectiveness of insulin prescribing safety interventions in UK hospitals

et al. 2020

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Aims To describe the use and validation of a survey tool to elicit the opinion of hospital pharmacists and medicines safety officers in the UK regarding the perceived effectiveness of strategies to improve insulin prescribing safety in hospitals. Methods One respondent from each participating organization completed the survey on behalf of the main acute hospital in their trust (n = 92). A five-point Likert scale was used to determine opinion on how effective 22 different interventions were at promoting insulin safety at the respondent's trust. The tool, the Perception of Effectiveness of Prescribing Safety Interventions for Insulin (PEPSII) questionnaire, underwent content validity testing. The reliability was estimated using Cronbach's alpha (a). Results The PEPSII questionnaire demonstrated good reliability (a = 0.867). Outreach team review and mandatory insulin education were the highest-scoring interventions; the insulin passport was amongst the lowest scoring interventions. Most interventions were considered more effective by trusts using them compared to those who didn't, except for self-administration policies, electronic prescribing and the insulin passport. Conclusions The perceived effectiveness of a variety of insulin prescribing safety strategies in UK hospitals was described by leveraging a purposely developed survey tool. The results describe current levels of support for recommended interventions, and may facilitate the direction of both local and national insulin prescribing safety improvement efforts.

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Strategies to reduce insulin prescribing errors in UK hospitals: results from a national survey

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.

Cited by 9 publications

References 22 publications

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

A Longitudinal Assessment of the Quality of Insulin Prescribing with Different Prescribing Systems

Evaluation of an implemented new insulin chart to improve quality and safety of diabetes care in a large university hospital: a follow-up study

Use and validation of a survey tool to measure the perceived effectiveness of insulin prescribing safety interventions in UK hospitals

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