Medicines Focus Bulletin

December 2010
Safer Administration of Insulin
In December 2010, the National Patient Safety Agency (NPSA) issued a Rapid Response Report
(RRR) to all hospital settings with actions to ensure the safe administration of insulin. Full details
are available from http://www.nrls.npsa.nhs.uk/resources/type/alerts/?
entryid45=74287

Why did the NPSA do this?

Errors in the administration of insulin by clinical staff are common. In certain cases they may be
severe and can cause death. Two common errors have been identified:

- the inappropriate use of non-insulin (IV) syringes, which are marked in ml and not in
insulin units;
- the use of abbreviations such as “U” or “IU” for units. When abbreviations are added to
the intended dose, the dose may be misread e.g. 10U is read as 100.

Some of these errors have resulted from insufficient training in the use of insulin by healthcare
professionals.

What has the NPSA asked us to do and how have we responded?

1. All regular and single insulin (bolus) doses are measured and administered using an
insulin syringe or commercial insulin pen device. Intravenous syringes must never be
used for insulin administration.

o All wards have a supply of insulin syringes available which are topped
up by general stores
o Prefilled insulin devices are available from pharmacy
o The trust Policies for the Prescribing, Supply and Administration of
Medicines and the Management of Diabetes have been updated to
include this information.

2. The term “units” is used in all contexts. Abbreviations, such as “U” or “IU” are never
used.
o Critical Care areas use an electronic prescribing system which
ensures units are specified in full.
o The new trust medication chart has a preprinted section for insulin
infusions where units in full is specified
o The trust Policy for the Prescribing, Supply and Administration of
Medicines requires units to be written in full.
o The Clinical Screening and Ward Pharmacy Guidelines state that units
should be written in full.

3. All clinical areas and community staff treating patients with insulin have adequate
supplies of insulin syringes and needles, which staff can obtain at all times.

o A further supply of syringes and needles is available in the emergency

drugs cupboard on both sites in case supplies run out “out of hours”
4. An insulin syringe must always be used to measure and prepare insulin for an
intravenous infusion. Insulin infusions are administered in 50ml intravenous
syringes or larger infusion bags. Consideration should be given to the supply and use
of ready to administer infusion products e.g. prefilled syringes of fast acting insulin
50 units in 50ml sodium chloride 0.9%.

o Critical Care areas use an electronic prescribing system which

specifies this information.
o The new trust medication chart has a preprinted section for insulin
infusions where the diluent and volume of diluent are specified.

5. A training programme should be put in place for all healthcare staff (including
medical staff) expected to prescribe, prepare and administer insulin. An e-learning
programme is available from: www.diabetes.nhs.uk/safe_use_of_insulin.

o This bulletin is being used to educate staff about the alert.

o Uptake will be monitored through the zero tolerance policy.

6. Policies and procedures for the preparation and administration of insulin and insulin
infusions in clinical areas are reviewed to ensure compliance with the above.

o The trust Policies for the Prescribing, Supply and Administration of

Medicines and the Management of Diabetes have been updated to
comply with the alert.

What can YOU do?

For staff prescribing insulin

What can YOU do?
Prescribers ask yourself:
• Does the prescription include both the words INSULIN in full and the brand name?
• Is the word UNITS written in full?
• Is the dosage form i.e. cartridge, pen, vial specified?
• Is the prescription dated?
• Is the prescription signed?
• Does the prescription include the contact details?
• If I am prescribing an insulin infusion have I used the pre-printed section of the chart?
• If something has gone wrong have I reported this as an incident on Datix?
For staff administering insulin
What can YOU do?
Ask yourself:
• Does the prescription include both the words INSULIN in full and the brand name? If it is
unclear which type of insulin has been prescribed contact the prescriber for clarification.
• Is the word UNITS written in full and the dose prescribed unambiguous? If not confirm with the
prescriber?
• Is the patient using a pen? If so am I confident in using it?
• Do I need to draw a dose up from a vial? If so do I have an insulin syringe available?
• If the prescription is for an insulin infusion is it prescribed on the correct section of the chart
and am I following the correct instructions for dilution?
• If something has gone wrong have I reported this as an incident on Datix

Written by Emily Hartwell, Senior Principal Pharmacist – Research and Governance, Dec 2010
Reference : NPSA – Rapid Response Report June 2010