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.

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