Insulin prescription and administration and blood glucose monitoring at Mater Dei Hospital

Abstract

Background: Incorrect insulin prescription and administration has been associated with substantial medication-related patient harm and mortality. We aimed to assess whether blood glucose was being monitored according to our local hospital protocol and whether insulin was being prescribed accurately by doctors and administered safely by nurses. Moreover, we evaluated whether education to nurses and doctors resulted in less insulin prescription and administration errors.

Methods: Inpatients on insulin in Mater Dei hospital’s medical wards were recruited. Data was collected from patients’ files on errors in insulin prescription and on the timing of blood glucose monitoring and insulin administration in relation to meals. The first audit was carried out in 2013. A re-audit was carried out in 2017 following education to doctors and nurses and a change in the treatment chart format. The z-test was used to compare the two audits.

Results: On re-auditing, a significant improvement was noted in the timing of blood glucose monitoring and insulin administration in relation to meals, in the legibility of the insulin doses, ‘Units’ were more written in full and supplementary Actrapid® was more frequently prescribed where indicated. However, inappropriate omission of fixed insulin doses occurred more often, while written instructions by doctors on when to administer fixed insulin, including supplementary Actrapid®, were still lacking. Moreover, there was no improvement in adherence to the supplementary Actrapid® algorithm by nurses.

Conclusion: Further education and an improved treatment chart including hypo- and hyperglycaemia trouble-shooting guidelines are required to further reduce insulin prescription and administration errors.