Insulin prescribing, administration, and glucose monitoring trends in Irish hospitals: scope for improvement?

Purpose: Insulin is a high-alert critical medicine used in the treatment of diabetes which bears a heightened risk of causing significant patient harm when used inappropriately and has been identified as a medication safety issue in Galway University Hospitals. The aim of this study was to conduct a local prospective audit on insulin prescribing, administration, and glucose monitoring trends in order to identify and develop quality improvement initiatives. Methods: This audit was conducted over one day in March 2022, approved by the local Clinical Audit Committee, piloted on two inpatients, and communicated to all data collectors prior to commencement. Generated data were anonymous and securely stored. Independent analysis was conducted by three researchers to confirm reliability of results. Results: 454 inpatients were reviewed of which 17% [75] had diabetes and 9% [41] were prescribed insulin. The overall insulin error rate with one or more errors comprising prescribing and/or administration per inpatient drug record was 90% [37]. In total, 95% [235] insulin brand names and 89% [220] dose units were clearly prescribed, 84% [208] administration times were clearly specified by a prescriber, 87% [214] orders were signed, 58% [25] prescribers clearly documented their registration number/bleep/name at least once for contact purposes, 35% [30] meal time supplements were documented clearly by a nurse, 70% [202] administrations were double checked by a second person, 53% [142] administration times were documented by a nurse, and 26% [10] of inpatients were administered insulin by a nurse when not prescribed. Conclusion: Results will assist in developing quality improvement initiatives to optimise patient care.