Insulin prescribing

The last few years have seen a significant rise in the number of patients requiring insulin. Unfortunately, the increasing number of different insulins and regimes available have been mirrored by a rapid increase in prescribing errors to the point at which insulin is the drug with the highest number of prescribing errors in the NHS. These errors were highlighted in a rapid response from the National Patient Safety Agency (NPSA) which described over 3881 patient safety incidents between 2003-2009 in England and Wales including one death and one severe harm incident. Although the latter hit the headlines, other errors including more minor incidents and ‘near misses’ undermine patient confidence as well as raise significant clinical governance issues.

Various actions have been implemented since this alert including the term ‘units’ being used when prescribing insulin rather than the previously common abbreviations ‘u’ or ‘iu’. Action has also been taken to ensure that insulin is only administered via a specific insulin syringe or pen rather than standard syringes. Finally training programmes have been developed for health care professionals involved in the care of patients with diabetes (e.g. the NHS diabetes e-learning course. Many acute trusts have since made this course mandatory for junior doctors. In the community errors have been reported in practices, via district nurses and from pharmacies, a frequent problem being the prescribing/ dispensing of Humalog rather than Humalog Mix 25 – a situation not helped by drop down menus in electronic prescribing.

Analyses of most prescribing errors show the cause to be due to inadequate knowledge of a drug of significant clinical benefit but also with the capacity to do great harm. A reduction will only occur with improved education of patients, health care professionals, and with greater involvement of the pharmacists.

Dr. Mark Freeman