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Did You Know? Average Error in Insulin Measurement among Healthcare Professionals and Patients

In a study published in Archives of Internal Medicine, healthcare professionals were asked to draw up a total of 5, 10, or 30 units of insulin as either human insulin 70/30 premix or a combination of regular + NPH….

The total number of units of insulin drawn up and mixed was assessed by weighing the contents of the syringe after they were expelled onto a weighing dish, and the total number of units drawn up was calculated. 

The healthcare professionals showed similar but less pronounced inaccuracies than patients in drawing up and mixing insulin. However, there were no statistically significant differences between patients and professionals with regard to accuracy at any dose. In addition, in both groups there was greater accuracy when premixed insulin was used. The following insulin administration techniques are recommended to reduce the risk for error.

 
Error-reducing Strategies: Administering Insulin
  1. Avoid administering insulin before pharmacist review of order.
  1. Institute independent double-check of IV insulin doses (including original order, dose, concentration, patient identity, route of administration, pump settings) before administration.
  1. Read-back all verbal insulin orders (e.g., saying “one-five units” instead of “fifteen units,” because it has been misheard as “50”; saying “one-four units” instead of “fourteen units” because it has been misheard as “40 units,” etc…).
  1. Confirm patient need for insulin (e.g., diabetes, hyperglycemia) before administration.
  1. Record measurements of blood glucose and insulin doses on appropriate forms or computer screens.
  1. Confirm compatibility of insulin before mixing.
  1. Use smart pumps for insulin infusions; if not available, use single-channel pumps, rather than dual-channel pumps, to prevent programming confusion.
  1. Place insulin tubing away from other tubing to prevent inadvertent rate adjustment or connection with other medications; label all tubing.
  1. If possible, communicate to the patient the entire insulin name and dose prior to administration; if appropriate, tell the patient the blood glucose level.
Source: Bell DS, et al. Arch Intern Med. 1991;151: 2265-2269