Background Insulin has been defined as one of the highest risk medicines worldwide, [1] with a 2009 national UK audit demonstrating prescribing errors in 19.5% of in-patient insulin prescriptions. [2] The NPSA (National Patient Safety Agency) Rapid Response Report, issued in June 2010, further highlighted errors in the administration of insulin by clinical staff and called for immediate action to improve insulin prescribing. [2]

Purpose In 2010, an audit of insulin prescribing was conducted at North Bristol NHS Trust (NBT), using the Patient Safety First ‘insulin prescription bundle’ data collection tool that focused on five key safety-critical prescribing elements. [4] Following the results of the 2010 audit and NPSA alert, an insulin prescription chart was developed with the aim of significantly improving insulin prescribing.

Materials and Methods On 4th October 2012, the impact of the NBT insulin prescription chart was examined during a one-day cross-sectional audit (incorporating all specialities), using a special data collection form developed from the ‘insulin prescription bundle’.[4] This incorporated five key audit standards:

1. All prescriptions written by brand name with the word ‘insulin’ included

2. The word ‘Units’ written in full

3. All prescriptions signed

4. All prescriptions dated

5. Insulin delivery device specified

Results In 2010, adherence to the five key elements was only seen in 3% of prescriptions (n = 68), with an increase to 74% (n = 54) post-chart initiation in 2012 (P = 0.007). Ward-based clinical pharmacists were found to have specified the insulin device in 81% (n = 42) of those prescriptions incorporating a device.

Conclusions By incorporating the five key prescribing elements in a specifically designed insulin chart, a statistically significant improvement in insulin prescribing was seen. Individual pharmacists also demonstrated a significant contribution in improving prescribing safety of this high-risk medicine, with an ultimate reduction in error potential and decreased risk of patient harm.

References

1. Belknap S. ‘High-alert’ medications and patient safety. Int J Qual Health Care 2001;13:339–40.

2. NHS Diabetes. Findings from the 2009 National Diabetes Inpatient Audit. Newcastle Upon Tyne: NHS Diabetes; 2010.

3. National Patient Safety Agency (NPSA). Rapid Response Report: Safer Administration of Insulin. London: NPSA; 2010.

4. Patient Safety First. Introduction and Data Collection Tool, 2010 [Online] [Accessed 2012 Sept 2]. Available from: www.patient safetyfirst.nhs.uk

No conflict of interest.