Wednesday , December 13 2017
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Accidents Will Happen But Damage Can Be Minimized

Over the years I have had many patients come into the pharmacy requesting a replacement bottle of insulin because they’ve accidentally dropped a bottle. Recently, a patient shared this experience:

“My vial of Regular insulin dropped to the floor and shattered. I was trying to draw up my pre-meal dose in the ladies room of an upscale restaurant. My husband Herb was waiting patiently at our table as our Cajun catfish Courtbouillon and shrimp creole were heating up. I could almost smell the thick, rich, fish stew brimming with flavor. But I needed my pre-meal insulin dose.”…

“On the way back to the table, I asked the head waiter if he knew of a pharmacy nearby where I could replace my insulin. Fortunately there was one at a mall within a mile of this bistro and regular insulin does not require a prescription.We asked the head waiter to hold our order and promised to return. 

We purchased the vial, along with an extra, and took a cab back. After my pre-meal bolus dose of my new Regular insulin, my husband and I totally enjoyed our dining experience. Never let it be said that our lives are less than spicy — whether or not we’re in New Orleans!

Returning home, I vowed I’d not let this happen again. Now, for each new vial of insulin I am about to open I wrap it completely with clear scotch tape.”

Lesson Learned: 

Between the hassle getting of an insurance company to pay for an extra vial of insulin and finding a way to get an analog insulin when they are out of town it makes sense to encourage your patients to protect their insulin vial from breakage. The patient above had osecuriteene solution (and if you know your patients are using this particular solution, be sure to emphasize that they not obscure the bottle label!) but there are also other solutions available such as Vial Protection by Securitee Blanket. Give your patients a written prescription for analog insulins or if possible change the patient to an insulin pen.

Merilee Kaufman

Report Medication Errors to ISMP:

Diabetes in Control is partnered with the Institute for Safe Medication Practices (ISMP) to help ensure errors and near-miss events get reported and shared with millions of health care practitioners. The ISMP is a Patient Safety Organization obligated by law to maintain the anonymity of anyone involved, as well as omitting or changing contextual details for that purpose. Help save lives and protect patients and colleagues by confidentially reporting errors to the ISMP.

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