Authors (including presenting author) :
Wong KKC (1), Yee ASW (1), Lau TWT (1), Lee HY (1), Lau WY (1), Tan KCB(2)
Affiliation :
1) Department of Medicine, Queen Mary Hospital, (2) Division of Endocrinology and Metabolism, Department of Medicine, The University of Hong Kong
Introduction :
Insulin is one of the High Alert Medications which will cause severe injury – hypoglycaemia if misused or wrongly administrated. Incidents happened before and the consequences could be devastating, correct insulin injection technique, procedure and nursing care is essential for minimizing risk. Incident might happen if insulin improperly given: i) Intravenous insulin could be lethal if given in substantially excessive amounts or in place of other medications ii) Mix-up due to look-alike names and packaging iii) Not using insulin pen devices according to manufacturer’s recommendation iv) Complex dosing regimen of sliding scale insulin and dosing errors from mis-programming of infusion pumps e.g., mixing up of infusion rates v) Inadvertent extra/missing dose due to missing attention to withholding criteria vi) Emerging insulin products with concentration other than the conventional 100 units/ml
Objectives :
i) To formulate training programme and link nurse system to enhance nurses’ knowledge in insulin use ii) To provide support and coaching for safe practice for insulin injection iii) To perform insulin administration audit
Methodology :
Education and training would be provided to enhance nurses’ knowledge of different kinds of insulin, injection devices, injection techniques, incidents sharing and related care. Diabetes Nurses would help coaching and support safe practices according to practice guidelines. Diabetes (DM) Link Nurse system would be established help reviewing and reinforcing frontline safe practice and keep communication with Diabetes Nurse team. Department of Medicine - DM Link Nurse Simulation Training with Scenario Based Training Workshop was done on 14 May 2024 (Attendance: 15) Besides, HKWC DM Link Nurse training was done on 23 & 30 Jul 2024 (attendance: 50) Insulin injection audit will also be performed by Diabetes Nurses starting in 3Q2024: aiming 66 auditees in performing insulin injection with the use of insulin syringes or pens in medical wards. NCMC e-corner education poster for subcutaneous insulin injection was circulated in Nov 2024. HKWC insulin injection safety workshop for DM Link Nurses or ward representatives with update knowledge and incidents sharing done on 2,5,10,12 Dec 2024 (attendances: 82) Training material is being shared at HKWC CND professional training website for review. Furthermore, Enhancement Programme for Diabetes Management for Junior nurse in HKWC would be done in 1Q 2025(Aiming Attendance: 80) Lastly, E-learning for further update and enhancement of knowledge in insulin injection will be done in 1Q 2025
Result & Outcome :
Evaluation done for nurses’ compliance with current standards of providing insulin treatment to patients correctly and safely. Post-evaluation was done for training and audit results, provision of feedback identifying areas for patient care improvement and further reinforcement in training and coaching. Nurses reported positive comments with increase competence in caring of patients with diabetes requiring insulin therapy. DM Link Nurse and DM Nurses would continue to support front-line care and uphold standard. Further insulin injection audit to be performed regularly. Medication incidents will also be monitored.
