Introduction. Guidelines for patient involvement in the administration of insulin under supervision in hospital (Adult patients)

Transcription

1 Guidelines for patient involvement in the administration of insulin under supervision in hospital (Adult patients) Introduction This guideline is designed to provide a framework for patients to administer their insulin dose while in hospital, ensuring appropriate supervision and accountability of hospital practitioners. This guideline describes patient involvement in the administration of insulin under direct supervision of nursing/midwifery staff and should not be confused with self-administration or self-management of insulin in hospital where the patient is not directly supervised. Medicines are usually administered to inpatients by hospital practitioners. However for patients who administer or intend to administer their own insulin outside hospital, it is important to facilitate their involvement in the administration of insulin in hospital when it is safe to do so. This will maintain pre-admission independence, provide opportunities to reinforce education and detect compliance issues for existing patients. It also enables newly diagnosed patients to learn to administer insulin themselves in preparation for discharge. Evaluation of a patient for involvement in insulin administration in hospital All adult patients on insulin should be evaluated on admission to hospital by a registered nurse/midwife for involvement in the administration of insulin using Appendix 1. The completed evaluation should be filed in the patient s nursing/midwifery notes. This evaluation should be reviewed at any stage following admission where changes occur that could affect patient involvement in insulin administration or where there are concerns about a patient s involvement in insulin administration. Storage All insulin must be stored securely in a locked fridge, locked medicine trolley or locked bedside medicine locker and access is restricted to nursing/midwifery/pharmacy staff. Opened insulin can be stored at room temperature for up to 28 days from the date of opening. Labelling All insulin products are single patient use only. The date of first opening should be entered at the time of first use. Ward stock each insulin should be labelled with the patient s name, H&CN/hospital number and date of birth by attaching a laboratory addressograph at the time of first use. Non-stock supply each insulin should be labeled with the patient name at the time of dispensing. Patient s own supplies check that the insulin is within expiry date, has not been removed from the fridge for more than 28 days, is labelled with the patient s name, Health &Care/Hospital Number and date of birth by attaching a laboratory addressograph to the vial, cartridge or pre-filled device.

2 Prescription Insulin must be prescribed by a prescriber having confirmed the patient s insulin regimen. Where a patient adjusts their insulin dose appropriate to their food intake and/or their blood glucose measurement, a range should be prescribed instead of a specific dose. Blood glucose monitoring Blood glucose monitoring must be conducted by a registered nurse/midwife using hospital glucose meters to ensure quality control of monitoring and a link to the laboratory results system. Blood glucose results must be recorded on the appropriate blood glucose monitoring chart. The patient should be informed of the result and encouraged to record the result in their own patient held record. Procedure for patient involvement in insulin administration in hospital When a patient has been evaluated for involvement in the administration of their insulin in hospital, the registered nurse/midwife should: Ensure that the ward has an adequate supply of the patient s insulin. Instruct the patient to alert the nurse/midwife 15 minutes before their insulin dose is due. Note that for patients who adjust their bolus dose of insulin according to their food intake and/or blood glucose measurement, the patient will not be able to determine the appropriate insulin dose until the meal has been delivered to the patient. Encourage the patient to continue recording their insulin dose in their own patient held record. Provide the patient with a patient information leaflet, in either standard or large print format (Appendix 2). When the patient alerts a registered nurse/midwife that a dose of insulin is due, the nurse/midwife should: Conduct measurement of blood glucose using the hospital glucose meter, inform the patient of the result and record blood glucose readings. Two nurses/midwives should: Make the insulin available to the correct patient and confirm this corresponds to the insulin prescription and the patient s current insulin regime. Encourage the patient to check it is the correct insulin. If this is incorrect, contact a prescriber. Check the patient s intended dose of insulin and confirm this corresponds to the prescribed dose or is within the prescribed dose range and relevant blood glucose reading. If a patient indicates that the prescribed dose or dose range is incorrect, contact a prescriber to review the prescription and amend if appropriate before a dose can be administered. Observe the patient measuring the dose and confirm this is correct prior to administration. Observe the patient administering the measured dose. Record administration on the prescription. Provide any necessary education and training required by the patient. Contact your Diabetes Link Nurse or the Diabetes Specialist Nurse if you require additional input for education and training of the patient. Ensure any sharps have been correctly disposed.

3 Return the patient s insulin to the locked medicine trolley or locked bedside medicine locker. Record of administration The supervising nurse/midwife s initials should be recorded together with (Self) to indicate that the patient has administered the dose. Where the patient is adjusting the dose of insulin according to food intake and/or blood glucose measurement, record the actual dose administered beside the administration signatures. Examples of recording are shown on the next page for insulin prescriptions chart and long stay Kardex [delete as appropriate]. Insulin prescription chart: nurse/midwife LW and nurse/midwife AD supervised a patient administering 12 units NovoRapid from a prescribed dose range of units. Long stay Kardex: nurse JR and nurse LI supervised a patient administering 12 units, 14 units and 16 units NovoRapid respectively at 08.30, and

4 Appendix 1 D Write in CAPITAL LETTERS or use addressograph Surname:... First Names:.... Evaluation of an adult patient for involvement in the administration of insulin under supervision in hospital Hospital number:... DoB: Hospital: Ward:... Consultant:... Date of evaluation 1. Does the patient self-administer or intend to selfadminister their insulin at home? Yes No Yes No Yes No 2. Does the patient wish to be involved in the administration of their insulin while in hospital? Yes No Yes No Yes No If the answer to 1 and 2 is no, the patient will not be involved in the administration of insulin and no further evaluation is required. 3. Does the patient have a clear understanding of the insulin type, dose, timing and use of the insulin Yes No Yes No Yes No device? 4. Is the patient at risk of known self harm? Yes No Yes No Yes No 5. Has the patient any physical difficulties that would prevent them being involved in the supervised Yes No Yes No Yes No administration of insulin e.g. manual dexterity? 6. Are there any other reasons why the patient should not be involved in the supervised administration of insulin? Specify: Yes No Yes No Yes No Patient to be involved in administration of insulin under supervision* Signature of registered nurse/midwife Yes No Yes No Yes No *If any answer is in a shaded box, the patient should not be involved in the administration of insulin in hospital. If a patient is not to be involved in the administration of insulin, consider referral to [Diabetes Link Nurse or Diabetes Specialist Team]. This evaluation should be reviewed at any stage following admission where changes occur that could affect patient involvement in insulin administration or where there are concerns about a patient s involvement in insulin administration. This form must be filed in the patient s nursing/midwifery notes.

5 Appendix 2 Involvement in the administration of my insulin in hospital under supervision Introduction (Adult patients) Information for patients You are a patient who requires insulin. Either you usually give (administer) your own insulin at home or you will be giving your own insulin after you go home. Your nurse/midwife has discussed your insulin with you and you will be involved in giving your insulin in hospital under the supervision of nursing or midwifery staff. Why should you be involved in the administration of your insulin? If you have been already been taking insulin before, it is important that you continue to give your own insulin in hospital so you are able to continue to do this when you leave hospital. If you have not taken insulin before, it is very important for you to be involved so you know exactly how to administer insulin after you leave hospital. What if you don t want to be involved in the administration of your insulin? If at any stage, you do not wish to be involved in giving your insulin in hospital, please tell your nurse or midwife and they will give you your insulin. If your condition or treatment changes during your hospital stay, for example you become very unwell or require a period of fasting (not eating or drinking any food or drink), it may be necessary for staff to manage your insulin treatment and give your insulin until it is considered safe for you to be involved in giving your insulin again. How is your insulin stored? In hospital, all medicines must be stored securely for the safety of all patients, visitors and staff. Your nurse/midwife will store your own insulin securely for you in a locked fridge, medicine trolley or locked bedside medicine locker. A label will be attached to your insulin with your name, date of birth and Health and Care/Hospital Number. Your nurse/midwife will check when you started using any opened insulin and that you have stored any unopened insulin in the fridge. If you need any more supplies of insulin while you are in hospital, these will usually be supplied from the hospital pharmacy.

6 How is your blood glucose monitored? It is important that your blood glucose is monitored regularly in hospital. The nurse/midwife looking after you will use the hospital meter to monitor your blood glucose. The results will be recorded in your hospital record. You should record the results in your own blood glucose records. You can continue to use your own blood glucose meter if you wish but these results will not entered in your hospital record. The hospital meter must be used by staff as it is regularly checked to ensure it is giving correct blood glucose readings and it is also linked to the laboratory results system. How is your insulin dose recorded? A doctor or other prescriber will check your insulin and dosage regimen with you on admission. Your insulin and dose will be prescribed for you in hospital. If you usually vary your insulin dose based on what you are eating, your dose will be prescribed as a range to accommodate this. If your insulin or dose is changed from what you were taking before, your doctor/nurse/midwife will tell you. Your dose will be checked by nursing/midwifery staff each time a dose is due. If you think that the insulin and dose on the prescription is not correct, tell the nurse or midwife and they will contact a doctor or other prescriber. What will happen when my insulin dose is due? You should tell a nurse/midwife 15 minutes before you are due to give your insulin so they can bring your insulin to you. Nursing/midwifery staff need to know exactly how much insulin you are giving yourself so they will check your insulin and dose with you, watch you give this and then sign a record that you have received it. How can I dispose of my sharps safely? All sharps need to be disposed of carefully. A nurse/midwife will provide you with a sharps bin for this. What if I have more questions? If you have any questions about your insulin or your diabetes, please ask your nurse/midwife.

7 Involvement in the administration of my insulin in hospital under supervision (Adult Patients) Information for Patients Contents Introduction Why should you be involved in the administration of your insulin? What if you don t want to be involved in the administration of your insulin? How is your insulin stored? How is your blood glucose monitored? How is your insulin dose recorded? What will happen when my insulin dose is due? How can I dispose of my sharps safely? What if I have more questions?

8 Introduction You are a patient who requires insulin. Either you usually give (administer) your own insulin at home or you will be giving your own insulin after you go home. Your nurse/midwife has discussed your insulin with you and you will be involved in giving your insulin in hospital under the supervision of nursing or midwifery staff. Why should you be involved in the administration of your insulin? If you have been already been taking insulin before, it is important that you continue to give your own insulin in hospital so you are able to continue to do this when you leave hospital. If you have not taken insulin before, it is very important for you to be involved so you know exactly how to administer insulin after you leave hospital.

9 What if you don t want to be involved in the administration of your insulin? If at any stage, you do not wish to be involved in giving your insulin in hospital, please tell your nurse or midwife and they will give you your insulin. If your condition or treatment changes during your hospital stay, for example you become very unwell or require a period of fasting (not eating or drinking any food or drink), it may be necessary for staff to manage your insulin treatment and give your insulin until it is considered safe for you to be involved in giving your insulin again. Back to Top How is your insulin stored? In hospital, all medicines must be stored securely for the safety of all patients, visitors and staff. Your nurse/midwife will store your own insulin securely for you in a locked fridge, medicine

10 trolley or locked bedside medicine locker. A label will be attached to your insulin with your name, date of birth and Health and Care/Hospital Number. Your nurse/midwife will check when you started using any opened insulin and that you have stored any unopened insulin in the fridge. If you need any more supplies of insulin while you are in hospital, these will usually be supplied from the hospital pharmacy. How is your blood glucose monitored? It is important that your blood glucose is monitored regularly in hospital. The nurse/midwife looking after you will use the hospital meter to monitor your blood glucose. The results will be recorded in your hospital record. You should record the results in your own blood glucose records. You can continue to use your own blood glucose meter if you wish but these results will not entered in your hospital record. The hospital meter must be used by staff as it is

11 regularly checked to ensure it is giving correct blood glucose readings and it is also linked to the laboratory results system. Back to Top How is your insulin dose recorded? A doctor or other prescriber will check your insulin and dosage regimen with you on admission. Your insulin and dose will be prescribed for you in hospital. If you usually vary your insulin dose based on what you are eating, your dose will be prescribed as a range to accommodate this. If your insulin or dose is changed from what you were taking before, your doctor/nurse/midwife will tell you. Your dose will be checked by nursing/midwifery staff each time a dose is due. If you think that the insulin and dose on the prescription is not correct, tell the nurse or midwife and they will contact a doctor or other prescriber.

12 What will happen when my insulin dose is due? You should tell a nurse/midwife 15 minutes before you are due to give your insulin so they can bring your insulin to you. Nursing/midwifery staff need to know exactly how much insulin you are giving yourself so they will check your insulin and dose with you, watch you give this and then sign a record that you have received it. How can I dispose of my sharps safely? All sharps need to be disposed of carefully. A nurse/midwife will provide you with a sharps bin for this. What if I have more questions? If you have any questions about your insulin or your diabetes, please ask your nurse/midwife. Back to Contents