Cross-Contamination Errors Using Insulin Pens

Some hospitals are taking cost containment to extremes, at least at the nurse levels.  This involves the reuse or multiple use of insulin pens among several patients. I have even been a victim of this. When I could not be sure that the insulin pen had not been used previously, I refused to let them use it on me. The nurse became angry and said their was no danger of cross-contamination. I said that the needle could do this by itself and that I would not allow this. The nurse became indignant and walked out.

Since I had my own insulin and insulin syringes, I waited until shift change and the nurse that came on then. She came in and asked why I had refused to let the nurse use the insulin pen. I explained that I could not tell how many people the pen had been used on and I was just protecting my health. I then asked her which insulin was in the pen. When she stated Levemir, I stated that I was on Lantus and Novolog and did not like Levemir. I explained that the pharmacist had approved my supply that I had with me and I would use that.

At that point, she insisted that she use their meter and lancet device and since she started with inserting a new lancet, I had no problems with that. After she had read my blood glucose and I had recorded it in my notebook, I opened my briefcase and took out my Novolog and started loading a new syringe. She asked why so much insulin and I explained that was my ratio because of insulin resistance and she would see what the reading showed when it was time for my Lantus.

Later, when it was time for my Lantus, the reading was right where I said it would be and she asked how many units I was taking. I told her and she questioned why I was stacking Lantus. I explained that the doctor had agreed to the splitting of the dosage between AM and PM because I was only obtaining about 18 to 20 hours of the duration of the 24-hour Lantus. I told her the hospital pharmacist had called the endocrinologist and confirmed this.

The safety of insulin pens had become the subject of a New York study in which 2,814 patients had reportedly been affected by insulin pen misuse. Then a Texas study in which 2,113 patients was reportedly exposed to disease transmission risk. These studies were presented by the Institute for Safe Medical Practices (ISMP) and in the process were used to recommend the return to vials and syringes for insulin injection.

This discussion is presented by a CDE that feels nurse education could mitigate the errors in the use of insulin pens and avoid the problems of insulin vials and syringes being misused. It is true that many abuses of vials of the wrong insulin and even problems of the incorrect syringes was and still is a problem in many hospitals, less attention is paid to the type of insulin pens used is also a problem. Many errors happen when the wrong type of insulin is injected because the nurses grab and go and forget to check that the pen is the correct type of insulin. The blog author thinks that insulin pens are important for patient satisfaction. This is one CDE that had better not cross paths with me, a confirmed vial and syringe user.

This is a reason to check and recheck what the nurse is injecting in you. I don't care that the nurse thinks she knows, I still insist on seeing the vial or pen to check that it is the correct insulin and what I use. Levemir is not a substitute for Novolog and diabetes management is important. Hospitals can make a mess out of this.

Safe Use of Insulin Vials

The Institute for Safe Medication Practices (ISMP) changes their mind again and is now urging hospitals to return to insulin vials and syringes and migrate away from the use of insulin pens in hospitals. This I can understand and appreciate as hospital personnel are nefarious for not following safe practices and creating cross patient contamination.

This is off topic, but the last time I was in the hospital, I lost count of the number of medical personnel that came by to listen to my heart and breathing. Did they clean their stethoscope before using it on me? Did they clean it before using it on the next patient? I cannot answer this positively, but the two times I asked, the doctor hesitated and said no. He asked why I asked, and I quickly said MRSA contamination. Then I next asked a nurse and was met with dead silence. I repeated the question and again received no answer. I then commented that it was no wonder we as patients needed to be concerned about safety and cross-contamination from other patients. This set off a litany of comments about patients not understanding medical procedures and should not be questioning their procedures.

Yes, we as patients need to be aware of the lack of safety procedures that are not practiced by our hospitals. Until hospital boards are faced with multimillion-dollar lawsuits for causing patient deaths, little with change from the top down. I emphasize top down, as there is no incentive for hospital staff to be concerned when policies do not come from the hospital boards to the administrators and then the department heads. Most often the staff is not made aware of good procedures and is told to be more careful to cut costs where possible. They see this as reusing needles for patients after patient, and creating cross contamination with both needles and insulin vials.

In this case, the Institute for Safe Medication Practices may be just flapping their gums, as without support at the highest levels of our hospitals, little will happen. I do give the ISMP good marks for recognizing some of the more egregious errors by hospital staffs. Hopefully the Centers for Medicare and Medicaid Services (CMS) will be able to aid in enforcement of some procedures.

I fear that the example used in the article may become commonplace and more deaths will occur. Most hospital staff is not aware of the distinction of insulin syringe and other parenteral syringes used by the hospitals. Medication errors will probably increase many times before the staff is made aware of the problems happening.

For patients entering the hospital, do everything in your power to discern the procedures followed by the hospital and if not an emergency hospital entrance, get as much in writing as possible allowing you the right to manage you own diabetes if possible. Do not trust this to the hospital for your own well-being.