Endocrine Abstracts

Patients with diabetes represent 15-20% of the total adult population in UK hospitals. Insulin is now recognised as the drug with the highest number of prescribing errors in the NHS. In order to determine insulin-related glycaemic morbidity we reviewed a random representative sample of 50 insulin prescription and administration records (25 medical and 25 surgical)over a 4 week period (11 T1DM, 39 T2DM) Initially we audited the legality of the prescriptions against well-described criteria. Next we assessed the hospital prescriptions for correctness by comparison against the usual insulin regimen, and finally used the full medical record to assess ‘appropriateness’ of both insulin prescription, adjustment and administration in relation to observed blood glucose values. We found that the majority of prescriptions were legal when measured against published criteria (insulin named, dose in units, times allocated, signed, legible, administration route, dated and with an identifiable prescriber). The most common areas of non-compliance were recording full insulin name and start dates. Correctness of prescription was less frequent, as admitting teams seem rarely to record the usual doses (56%), type (72%), times (42%) and control levels on insulin (18%) in the clerking documentation. As a result of this although 58% of patients have a deliberately altered insulin dose on admission to hospital, 10% of patients have a different insulin prescription through apparent oversight. The data with respect to appropriate adjustment of insulin doses were also problematic. Overall, 80% of this sample would have benefitted from insulin adjustment for either recurrent hyperglycaemia or recurrent hypoglycaemia during admission, despite this rates of adjustment were low (see table). In summary, in order to effect improvements in glycaemia control in hospital, prescription and administration appropriateness need to be aggressively targeted in addtition to prescription legality. This will require significant education and re-organisation of prescribing processes.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.

Insulin Adjustment during admission