What makes an insulin prescription safe?

As you have already seen, there are over 30 types of insulin available for use by patients with diabetes.

Whether working in a community clinic or in a hospital, it is essential that the healthcare professional responsible for prescribing insulin observes safe actions to reduce the risk of harm to a patient.

In week 2, this course outlined the types of insulin available for clinical use. If there is any doubt on the part of the healthcare professional about which insulin is appropriate, they should ALWAYS check with their local diabetes specialist or other appropriately skilled relevant healthcare professional.

Local prescribing processes and policies should always be observed.

1. Firstly, it should be ensured that the scheduled insulin prescription is for the CORRECT patient.
2. Indelible ink should be used if handwriting the prescription and the word ‘Insulin’ should be written if not pre-printed.
3. In the United Kingdom, the CORRECT insulin is prescribed by brand name (e.g. rapid acting insulin lispro is prescribed as Humalog).
4. The CORRECT dose (in Units) of insulin for administration should also clearly be documented.
   • In the United Kingdom, Doctors nationally are advised not to use abbreviations for the word Unit, e.g.; ‘U (Unit), IU (International Unit). Anywhere on drug charts or in nursing medical notes – the word “units” should be written in full if not pre-printed.
   • Nursing staff who are responsible for administering the insulin are encouraged to seek dose clarification if any aspect of the insulin prescription is unclear.

   Did you know? There have been cases nationally where the U has been mistaken for a zero i.e. 10U has been taken to mean 100 units and patients have come to harm from a dangerous low blood glucose level (hypoglycaemia) as a consequence.

5. The CORRECT frequency and CORRECT timing of insulin is also important to optimise its clinical action at the right time.

   • As a rule, rapid acting or short acting insulins are given with meals

   • Mixed insulins (which contain rapid or short acting insulin) are given with meals

   • Intermediate acting insulins can be once or twice daily, before breakfast or at bedtime

   • Once daily long acting insulins are usually given first thing in the morning or at bedtime, but same time daily

6. The name of the prescriber, contact details & prescribing date should be clear.

For a patient who is in hospital:

• Insulin for a patient with type 1 diabetes should NEVER be omitted, as they risk developing dangerously high blood glucose levels as a consequence, which can be harmful.
• After treating hypoglycaemia, a 10-20% dose reduction of insulin may be necessary.