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Delegation of insulin administration: a survey of community nursing teams in England

02 May 2024
Volume 29 · Issue 5


In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% (n=93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% (n=3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety.

Delegation of medicines administration from a regulated health professional such as a registered nurse (RN) to a healthcare support worker (HCSW) is practised in community settings in a range of countries (Shore et al, 2022). In this article, a HCSW (such as a healthcare assistant or an assistant practitioner), is an employee providing healthcare support, usually as part of a community nursing service provider. Healthcare can also be delegated to care workers in social care. Recent guidance on delegation in health and social care defines a delegated healthcare intervention as ‘a health intervention or activity usually of a clinical nature, that a registered healthcare professional delegates to a paid care worker’ (Department of Health and Social Care (DHSC) and Skills for Care, 2023). Delegation should be embedded within person-centred care, in the best interest of, and in collaboration with the person receiving care (DHSC and Skills for Life, 2023).

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