Insulin safety is a key priority nationally for healthcare organizations, the Institute for Safe Medication Practice (ISMP) Canada and provincial governments. There is a growing interest in the adoption of insulin pens in the hospital setting as a means to improve insulin administration safety and ensure continuity of insulin product use by the patient from the community to the hospital setting and at discharge.
It is believed that converting from insulin vials and syringes to insulin pens will:
Decrease medication incidents
Enhance knowledge of insulin and insulin pen devices in the hospital setting
Positively impact the patient experience related to insulin administration
Improve nursing workflow and workload related to insulin administration
Enhance continuity of care by reflecting the widespread use of insulin pens in the community setting
The Pharmacy leaders at the University Health Network (UHN) and Hamilton Health Sciences (HHS) agreed upon a collaboration for insulin pen implementation in 2013 as both organizations were undertaking conversion to insulin pens at one or more of their sites. The knowledge gained from this project led to the development of a toolkit to provide guidance and stewardship to other healthcare organizations in the safe implementation of insulin pen use in a variety of adult patient care settings.
The collaboration examined the following:
To evaluate the effectiveness of the toolkit tools in the safe conversion to insulin pens on selected patient care areas at HHS and UHN
To evaluate outcome measures related to insulin administration to further inform healthcare organizations
To evaluate the work flow and workload changes related to conversion from insulin vials and syringes
To facilitate knowledge translation principles of synthesis, dissemination, exchange and application of knowledge to improve health services
To evaluate outcome measures related to insulin administration
To capture lessons learned for the benefit of other healthcare organizations
To develop a best practice education and implementation plan for replication by other healthcare organizations across the country
In order to help other organizations embark on the shift in clinical practice to use of insulin pens, UHN and HHS have developed a toolkit within the framework of five guiding dimensions of what is required to successfully achieve such a practice change. This framework is supplemented, in a series of appended documents, with checklists designed as considerations for healthcare organizations to take into account as they contemplate this clinical practice change.
The framework offered in the toolkit captures the essence of the UHN and HHS experience and is offered from an evidence based perspective on the essential components for successful adoption of clinical practice changes related to insulin administration.