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.
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