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Creating sustained and positive changes to patient safety: reducing insulin administration errors in a district nursing service

02 March 2022
11 min read
Volume 27 · Issue 3


Administering insulin in a patient's own home is perceived as a simple nursing intervention, and one that is regularly delegated to newly qualified staff, agency and bank staff. However, without robust processes and clear, easy-to-follow nursing documentation in place, a simple nursing intervention can easily lead to an avoidable medication error and patient safety incident. This article describes the steps one trust has taken to combat insulin administration incidents. The article describes the use of a Plan, Do, Study, Act (PDSA) cycle to help test changes and roll out sustainable transformation. It describes some of the challenges faced, alongside the solutions tested and embedded into practice.

The treatment of diabetes within the community has undergone radical change over recent years with the launch of new therapies, including new insulins, bio-similar insulins and incretin mimetics (Smyth, 2020). At the same time, organisations have made changes to workforces through skills mixing and reorganisation of services, resulting in a need to delegate the administration of insulin, safely, to a wide range of different staff working at varying grades, including assistant practitioners, nurse associates, health care support workers and, additionally, care home staff. To support these changes, a range of resources have been made available nationally, including e-study modules, such as ‘Insulin safety e-learning’ (Trend Diabetes, 2020) and ‘An integrated career and competency framework for adult diabetes nursing’ (Trend Diabetes, 2021), together with ‘Competency framework and workbook: blood glucose monitoring and subcutaneous insulin administration’ (NHS, 2020).

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