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One Pen, One Patient

May 13, 2014

I am a bit perplexed at the resurgence of the discussion to ban insulin pens from use in the hospital setting.  The question being whether insulin pens are posing a health risk to patients over the use of insulin vials and syringes.

I recognize the concern over cross-contamination of bodily materials when a pen is used for more than one patient which could potentially pose a risk to patient safety.  In early 2013, there were multiple articles presented by the Institute for Safe Medical Practices (ISMP) urging the discontinuation of pen use, reporting that 2,814 patients had reportedly been affected by insulin pen misuse in New York over a four-year period.  In addition, 2,113 patients in Texas were reportedly exposed to disease transmission risk (ISMP Medication Safety Alert: 18(4), 2013).  ISMP in a recent Safety Brief (ISMP Medication Safety Alert: 19(6), 2014) stated that although there is evidence of contamination of hemoglobin, squamous cells and red blood cells into the insulin pen reservoir, there has not been a case of disease transmission.  This does not, however, negate the concern.

Patient safety is of huge concern at all times. However, one must also be concerned about risks of inaccurate dosing using syringes.  Accuracy of drawing up insulin doses, using the correct syringe, and using the correct type of insulin remain areas of concern.  Evidence suggests that the utilization of insulin pens reduce dosing errors and costs and improve patient and nurse satisfaction (Hosp Phar: 48(5), 2013). In addition, most patients use insulin pens at home, so teaching insulin administration is seamless. Nurse education, labeling of insulin pens and single-use pen needles all minimize the risks of errors in using pens for multiple patients or reusing needles. Insulin companies have programs to support education for nurses and staff and surveys to help gather information on knowledge regarding insulin pen use. 

Using insulin pens vs. insulin syringes is an ongoing discussion.  It appears that the risks of insulin pens are relatively small and should be overcome by initial nurse education and continued follow up such as posters in nursing pods and mandated continuing education via seminars and internet education modules. Unfortunately, human errors in medication administration remain a challenge in all areas of patient care.  The benefits of using insulin pens are improved patient and nurse satisfaction, reduced errors in insulin administration, and seamless education for patients from hospital to home.  Pens appear to be a positive overall choice in considering patient care.

What choice have you made with your hospital safety team, and how are you implementing safe insulin administration from medical staff to patient to home?  Please share!

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  1. May 15, 2014

    I would have a concern with going back to vial and syringe as ISMP had suggested. We have so many new graduates of nursing, and turnovers are high, that have never learned a vial and syringe method. I agree that there are multiple errors that could be made that way. Don't take two steps back trying to correct a problem- work on the source of the problem with, as you mentioned, more education. The devices are not wrong, just the usage. If we correct knowledge so that is not a problem, it is fixed.

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