Meeting News Coverage

Double monitoring of insulin doses offers minimal protection against in-hospital errors

NEW ORLEANS – An insulin double-checking procedure was ineffective at preventing insulin errors when compared with usual care procedures in patients with diabetes, according to study findings presented here.

In a prospective, comparative, two-group research study involving five inpatient units conducted at Cleveland Clinic, researchers found that a subcutaneous insulin double-checking procedure did lead to fewer insulin administration errors; however, most errors were due to the timing of insulin administration, which double-checking did not reduce.

“After controlling for clinical nurses who administered insulin, the double-checking intervention was effective in reducing omission errors, but not effective in wrong time, preparation, dose or a combination of two errors,” Mary Beth Modic, DNP, RN, CNS, CDE, a clinical nurse specialist in diabetes at the Cleveland Clinic told Endocrine Today. “The research findings do not support the practice of requiring a subcutaneous insulin double-checking procedure.”

Modic and colleagues analyzed data from 266 patients (mean age, 62.5; 51.9% men; mean BMI, 30.6 mg/kg2) during a 4-week period from five hospital units who had a total of 5,328 insulin administration periods. The five hospital units were randomly assigned to either usual-care procedures (3,243 insulin administrations) or the insulin double-checking procedure (1,993 insulin administrations). Patients in the double-check group were more likely to be older, obese and white, but there were no between-group differences in sex and diabetes type.

Overall, 3,473 insulin administration periods had no errors. The double-check group had more no-error periods compared with the usual-care group (44.9% vs. 36.7%; P < .001). The usual-care group had more errors of wrong time (33.3%) compared with the double-check group (27.6%). The usual-care group also had more errors of omission when (2.6%) when compared with the double-check group (0.8%).

Researchers found that the double-check group was less likely to have time-related errors, but noted that timing errors could not be solved with double-checking interventions.

“Wrong time errors can reflect non-nurse caregiver factors, such as no insulin or insulin administration products available on the nursing unit which are needed during the dosing period, unclear or ambiguous prescriptions that require communication and resolution with the prescriber or patient issues where patients are snacking on food brought from home,” Modic told Endocrine Today.

In addition, Modic said, each double checking insulin procedure averaged 5 minutes to complete, adding to the delay of timelyi insulin administration.

“We want to protect our patients, but many times, we are asking things that are non-sustainable,” Modic said during the presentation. “The evidence will show that this is true for double checking insulin.”

Modic cautioned that the study needs to be replicated at other hospitals. In addition, Modic said, diabetes educators should participate in work redesign initiatives that include equitable assignments of patients requiring insulin, readily available insulin products on inpatient units, detailed insulin administration instructions and nurse notification of meal delivery to facilitate timely insulin administration.

“There are so many impediments in the work flow process,” Modic said. “We have to ferret those out so that nurses can be successful.” by Regina Schaffer

Reference:

Modic, Mary Beth. W18. Presented at: The American Association of Diabetes Educators Annual Meeting 2015; August 5-8, 2015; New Orleans.

Disclosure: Modic reports no relevant financial disclosures.

Editor's Note: On August 10, we corrected data in the fourth and fifth paragraphs to reflect the correct numbers. The Editors regret this error. 

NEW ORLEANS – An insulin double-checking procedure was ineffective at preventing insulin errors when compared with usual care procedures in patients with diabetes, according to study findings presented here.

In a prospective, comparative, two-group research study involving five inpatient units conducted at Cleveland Clinic, researchers found that a subcutaneous insulin double-checking procedure did lead to fewer insulin administration errors; however, most errors were due to the timing of insulin administration, which double-checking did not reduce.

“After controlling for clinical nurses who administered insulin, the double-checking intervention was effective in reducing omission errors, but not effective in wrong time, preparation, dose or a combination of two errors,” Mary Beth Modic, DNP, RN, CNS, CDE, a clinical nurse specialist in diabetes at the Cleveland Clinic told Endocrine Today. “The research findings do not support the practice of requiring a subcutaneous insulin double-checking procedure.”

Modic and colleagues analyzed data from 266 patients (mean age, 62.5; 51.9% men; mean BMI, 30.6 mg/kg2) during a 4-week period from five hospital units who had a total of 5,328 insulin administration periods. The five hospital units were randomly assigned to either usual-care procedures (3,243 insulin administrations) or the insulin double-checking procedure (1,993 insulin administrations). Patients in the double-check group were more likely to be older, obese and white, but there were no between-group differences in sex and diabetes type.

Overall, 3,473 insulin administration periods had no errors. The double-check group had more no-error periods compared with the usual-care group (44.9% vs. 36.7%; P < .001). The usual-care group had more errors of wrong time (33.3%) compared with the double-check group (27.6%). The usual-care group also had more errors of omission when (2.6%) when compared with the double-check group (0.8%).

Researchers found that the double-check group was less likely to have time-related errors, but noted that timing errors could not be solved with double-checking interventions.

“Wrong time errors can reflect non-nurse caregiver factors, such as no insulin or insulin administration products available on the nursing unit which are needed during the dosing period, unclear or ambiguous prescriptions that require communication and resolution with the prescriber or patient issues where patients are snacking on food brought from home,” Modic told Endocrine Today.

In addition, Modic said, each double checking insulin procedure averaged 5 minutes to complete, adding to the delay of timelyi insulin administration.

“We want to protect our patients, but many times, we are asking things that are non-sustainable,” Modic said during the presentation. “The evidence will show that this is true for double checking insulin.”

Modic cautioned that the study needs to be replicated at other hospitals. In addition, Modic said, diabetes educators should participate in work redesign initiatives that include equitable assignments of patients requiring insulin, readily available insulin products on inpatient units, detailed insulin administration instructions and nurse notification of meal delivery to facilitate timely insulin administration.

“There are so many impediments in the work flow process,” Modic said. “We have to ferret those out so that nurses can be successful.” by Regina Schaffer

Reference:

Modic, Mary Beth. W18. Presented at: The American Association of Diabetes Educators Annual Meeting 2015; August 5-8, 2015; New Orleans.

Disclosure: Modic reports no relevant financial disclosures.

Editor's Note: On August 10, we corrected data in the fourth and fifth paragraphs to reflect the correct numbers. The Editors regret this error. 

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