Policy for the safe administration of Insulin

Transcription

1 Policy for the safe administration of Insulin This is a working document and any changes that become necessary to this policy must be Notified in writing to the Medicine Management Group via the Chief Pharmacist, East Cheshire Trust The Medicines Management Group Version 1: Nov 2010 Review:

2 Policy Title: Executive Summary: Policy for the administration of Insulin This document provides nursing, pharmacy and medical staff with a clear framework of how to administer insulin at ward level. It should be used in conjunction with the Medicines Policy. Supersedes: Description of Amendment(s): Policy for the safe administration of Insulin The policy is now fully compliant with the Trust Policy on Procedural Documents. This policy will impact on: All health professionals working on wards where administration of insulin is being implemented. Financial Implications: None. Policy Area: Medicines Management Document Reference: Version Number: 1 Effective Date: Jan 2011 Issued By: Author: Chair of Medicines Management Group Jabeen Razzaq-Sheikh Highly Specialised Pharmacist for Surgery and Anaesthesia Review Date: Jan 2012 Impact Assessment Date: Consultation: Approved by Director: Received for information: APPROVAL RECORD Committees / Group Management clinical and associate directors for each Business Unit TCC Specialist Advice (if required) Other (please specify) Medicines Management Group Medical Director Director of Nursing and Patient Care Standards Trust SQS Committee Date

3 1. INTRODUCTION 1.1 Background Information NPSA /2010/RRR013 Safer administration of insulin was issued on 16 June 2010 and was in response to receiving 3881 wrong dose incident reports (August 2003 to August 2009) involving insulin. Insulin is frequently included in the list of top 10 high alert medicines worldwide. Three deaths and 17 other incidents between January 2005 and July 2009 were reported where an intravenous syringe was used to measure and administer insulin. The use of intravenous syringes to measure insulin doses in units is an error prone practice as the graduations are in volume not units of activity. 1.2 Policy Statement This policy aims to support the implementation of the National Patient Safety Agency (NPSA) guidance on the safer administration of insulin 1.3 Aims The aim of this policy is to ensure that: The right patient receives the right insulin, at the right dose and at the right time. The most appropriate insulin syringe is used to prepare and administer insulin. The most appropriate technique is used to administer insulin with an insulin syringe The most appropriate technique to inject insulin using the most commonly used pens. To ensure the correct technique is used to administer insulin To be aware of other delivery systems used to administer insulin.

4 1. Insulin Syringe Size Products shown not actual size BD insulin syringes are available in these sizes: If the dose is... Use this capacity syringe 30 units or less, measured in half-units 3/10 ml/cc (30 units) with half-unit markings 30 units or less, measured in whole units 3/10 ml/cc (30 units) with whole unit markings 31 to 50 units 1/2 ml/cc (50 units) 51 to 100 units 1 ml/cc (100 units) Choose the smallest syringe that's big enough to hold the largest dose. The smaller the syringe, the easier it is to read the markings and draw up an accurate dose. If the largest dose is close to the syringe's maximum capacity, wards should stock the next size up to handle any increases in the dose adjustments. For example, if the dosage is 29 units and you buy a 3/10 ml syringe, you won't be able to use those syringes if the dosage increases to 31 units. BD 3/10 ml syringes are available with two different kinds of barrels: one with dosage markings at every unit and one with dosage markings at every half-unit. People who take whole unit insulin doses of less than 30 units should use the BD syringe with markings at every unit, because its large, easy-to-read markings make it simple to draw up an accurate dose. People who take very small doses (such as children) and who are told to measure their doses in half units (such as 2 ½ units or 5 ½ units) should use the BD syringe with dosage markings at every half unit.

5 1. Injecting insulin with a syringe It is important to know how to draw up and inject your patients with insulin properly. By learning to use the proper technique, you can give your patients injections quickly, accurately and with a minimum of discomfort and inconvenience. These are guidelines on how to inject insulin with a syringe. Always check the label on the insulin vial for any special instructions and the expiry date. If the insulin is cloudy, roll the vial gently between your hands several times in order to mix it completely. Remove the white cap covering the plunger. Carefully remove the orange needle cap. Pull back the plunger to measure an amount of air equivalent to the amount of insulin required. With the vial standing upright, insert the needle through the centre of the rubber cap of the insulin vial and push the plunger down. This expels the air into the vial, making it easier for you to draw out the insulin. Turn the vial upside down. Make sure the point of the needle inside the vial is well beneath the surface of the insulin. Pull back the plunger gently until you have measured slightly more than your correct dose of insulin. If any air bubbles are in your syringe, remove them. Flick or tap the syringe at the bubbles with your finger. When the air bubbles go to the top, push the plunger back to the desired dose expelling the bubbles into the vial.

6 Remove the needle from the vial and perform your injection. When you've finished, remove the syringe and dispose in a sharps bin.

7 2. Injecting insulin with a pen These are general guidelines common to most pen devices. It is important to read the manufactures instruction for all pens. Pens are usually for patient use only but nursing staff may administer from a pen if they are teaching patients on ho Pull off the cap of the pen. If your pen needs a cartridge, remove the cartridge holder from the pen body. Put an insulin cartridge into the holder. Reattach the holder to the pen body. If the insulin is cloudy, gently tip the pen 10 times and roll it between the palms of your hands 10 times to mix it. Screw on a new needle before each injection. Remove the outer cap of the needle, then the inner cap. Before each injection, check the pen is working. Set the dial to 2. With the pen pointing upwards slowly press the button. A tiny bead of insulin should appear at the needle tip, if not, dial and press the button again until you see it. N.B. Incretin hormone pens do not need priming. Set the dose that your nurse has told you.

8 With the pen prepared for your injection, push the needle all the way into the skin and inject your insulin. Hold down the button for at least 10 seconds after the dial has returned to zero to make sure you get all the insulin you need. Take out the needle slowly. When you've finished, remove the needle with the larger outer cap and/or place it in a sharps box, ready for disposal.

9 3. Good Injection Technique Ensuring the right technique while injecting is very important to maintain good BMs, just like the dose and type of insulin delivered. a) Injecting Correctly Insulin needs to be absorbed steadily to work properly and subcutaneous tissue is the best layer to do this. This ensures that the insulin is released smoothly and helps to regulate BMs. If the needle goes deeper, the injection will go into the muscle tissue. Unlike subcutaneous tissue, muscle absorbs insulin rapidly, which could cause a hypo and intramuscular is more painful. We know you need to inject into the subcutaneous layer. For most people, using a short (e.g. 5mm) needle is ideal to make sure the end of the needle is in the subcutaneous layer and doesn't go deeper reaching the muscle layer. Only short needles need to be injected in the arm. Others (e.g. using an 8mm) may need to injected into the skin fold. And, remember; leave the needle in for at least 10 seconds after you have pressed the plunger to make sure that all of the insulin is injected properly.

10 b) Lift a fold of skin(a gentle pinch) In a suitable area take a fold of skin between the thumb, index and middle finger. Only lift the skin - not the muscle below it. With the pen correctly prepared for the injection, push the needle fully into the skin at the peak of the fold. Proceed with your injection. The grip on the skin should be maintained throughout the injection. Remove the needle slowly, releasing the skin at the same time. c) Rotation. There are three areas that generally could be used for injecting: thighs, abdomen and buttocks. Note: the arms can be used as an injection site if advised. The main reason for rotating between and within sites is to make sure you don't keep injecting in the same spot each time. The reasons are The speed of insulin absorption varies from site to site. So it's important to develop a pattern where you are injecting in different sites throughout the day. Doing this helps you control your blood glucose levels. If you inject in the same spot regularly the tissue beneath may harden - a condition known as lipohypertrophy (or lipos as they are often called)

11 4. Other ways to administer Insulin While injecting with a syringe or insulin pen are the most popular methods of insulin delivery, other options exist: Insulin Pump Insulin pumps are about the size of an electronic pager and can be worn on a belt or in a pocket. They deliver insulin through a flexible tube inserted under the skin near the abdomen. The user gets a continuous flow of basal insulin, as well as larger bolus doses that are released by pressing a button at mealtimes or at other times when blood sugar levels are above the target range. By providing a small yet constant flow of insulin, insulin pumps mimic the way a healthy pancreas works. For people who keep a close eye on their blood glucose levels, activity levels, and diets, insulin pumps may provide better glucose control and might allow for greater flexibility in your insulin regimen. However, insulin pumps require attention in order for them to give good results: You need to learn how to operate a pump before you can use it effectively. You need to know how to count carbohydrates, calculate insulin-to-carbohydrate ratios, and adjust the insulin as necessary before meals and activities. You need to monitor the blood glucose levels four to six times per day. There's an increased risk of moderate to severe low blood sugar, also known as hypoglycemia. There's a risk of inflammation and infection at the insertion site. There's an increased risk for hyperglycemia and ketoacidosis if the insulin delivery is interrupted in any way. An insulin pump is usually worn 24 hours per day, seven days per week. Please note that only rapid analogues or soluble insulin can be used in pumps

12 Jet Injector Jet injectors are devices that force a tiny stream of insulin through the skin by pressure. Unlike syringes and insulin pens, jet injectors don't puncture the skin, which is good news for people who are afraid of needles. However, jet injectors do have their downsides, and as a result, are not routinely used as alternatives to syringes: The pressure used by the jet injector to deliver the insulin can cause bruising if the correct technique isn't used consistently. Some people feel that they are more painful than injections with insulin needles. It takes a lot of time to clean a jet injector and prepare the insulin dose. Although newer jet injectors use disposable injection chambers, these tend to be expensive. Insulin Infuser Infusers minimize needle sticks by creating a portal that you inject insulin into. A small tube is inserted into the fatty tissue of the injection site (typically the abdomen), and taped in place for two or three days. Insulin is injected with a traditional syringe or insulin pen into the tube instead of through the skin. Increased risk of infection and a lot of discomfort are the main drawbacks of infusion sets.

13 APPENDIX 1 Equality and Human Rights Policy Screening Tool Policy Title: Self-Medication Policy Directorate: Trust Wide Name of person/s auditing / authoring policy: Deputy Chief Pharmacist for Clinical Services Policy Content: For each of the following check whether the policy under consideration is sensitive to people of a different age, ethnicity, gender, disability, religion or belief, and sexual orientation? The checklist below will help you to identify any strengths and weaknesses of the policy and to check whether it is compliant with equality legislation. 1. Check for DIRECT discrimination against any minority group of PATIENTS: Question: Does the policy contain any statements which may disadvantage people from the following groups? Response Action required Resource implication Yes No Yes No Yes No 1.0 Age? X X X 1.1 Gender (Male, Female and Transsexual)? X X X 1.2 Learning Difficulties / Disability or Cognitive Impairment? X X X 1.3 Mental Health Need? X X X 1.4 Sensory Impairment? X X X 1.5 Physical Disability? X X X 1.6 Race or Ethnicity? X X X 1.7 Religious Belief? X X X 1.8 Sexual Orientation? X X X 2. Check for DIRECT discrimination against any minority group relating to EMPLOYEES: Question: Does the policy contain any statements which may disadvantage employees or potential employees from any of the following groups? Response Action required Resource implication Yes No Yes No Yes No 2.0 Age? X X X 2.1 Gender (Male, Female and Transsexual)? X X X 2.2 Learning Difficulties / Disability or Cognitive Impairment? X X X 2.3 Mental Health Need? X X X 2.4 Sensory Impairment? X X X 2.5 Physical Disability? X X X 2.6 Race or Ethnicity? X X X 2.7 Religious Belief? X X X 2.8 Sexual Orientation? X X X TOTAL NUMBER OF ITEMS ANSWERED YES INDICATING DIRECT DISCRIMINATION = 0

14 3. Check for INDIRECT discrimination against any minority group of PATIENTS: Question: Does the policy contain any conditions or requirements which are applied equally to everyone, but disadvantage particular people because they cannot comply due to: Response Action required Resource implication Yes No Yes No Yes No 3.0 Age? X X X 3.1 Gender (Male, Female and Transsexual)? X X X 3.2 Learning Difficulties / Disability or Cognitive Impairment? X X X 3.3 Mental Health Need? X X X 3.4 Sensory Impairment? X X X 3.5 Physical Disability? X X X 3.6 Race or Ethnicity? X X X 3.7 Religious, Spiritual belief (including other belief)? X X X 3.8 Sexual Orientation? X X X 4. Check for INDIRECT discrimination against any minority group relating to EMPLOYEES: Question: Does the policy contain any statements which may disadvantage employees or potential employees from any of the following groups? Response Action required Resource implication Yes No Yes No Yes No 4.0 Age? X X X 4.1 Gender (Male, Female and Transsexual)? X X X 4.2 Learning Difficulties / Disability or Cognitive Impairment? X X X 4.3 Mental Health Need? X X X 4.4 Sensory Impairment? X X X 4.5 Physical Disability? X X X 4.6 Race or Ethnicity? X X X 4.7 Religious, Spiritual belief (including other belief)? X X X 4.8 Sexual Orientation? X X X TOTAL NUMBER OF ITEMS ANSWERED YES INDICATING INDIRECT DISCRIMINATION = 0 Signatures of authors / auditors: Date: Equality and Human Rights Compliance / Percentage Calculation Number of Yes answers for DIRECT discrimination. (A) 0 Number of Yes for INDIRECT discrimination. (B) 0 Total answers for POLICY CONTENTS discrimination. (A+B) 0 Percentage content non compliant = 0 (Divide a+b by 36 x 100)

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