Insulin Medication Errors in
PDF Version of
BQA 03-014 (PDF, 19 KB)
DATE: October 14, 2003 DSL-BQA-03-014
TO: Nursing Homes NH 08
FROM: Michael J. Steinhauer, Resident Care Review Section,
Bureau of Quality Assurance
via: Susan Schroeder, Director, Bureau of Quality Assurance
Over the past few years there has been an increase in the options for
delivery of insulin therapy available for treating diabetes. Unfortunately,
medication errors involving insulin still are identified as one of the top ten
medication errors in many facilities. In many medication safety programs,
insulin is identified as a high-risk medication due to the errors that occur
with this class of medication.
The Bureau of Quality Assurance (BQA) has identified medication errors
involving insulin through the nursing home survey process. Many of the errors
involve the newer types of insulin and are related to the timing of insulin
administration. This memo provides information on recommended procedures for
administering insulin. Providers should always consult with their consultant
pharmacist, physician and the manufacturer guidelines prior to administering
insulin to assure it is being administered properly.
Insulin is classified into five categories: Rapid-Acting, Short-Acting,
Intermediate-Acting, Long-Acting and Combination. Many medication errors
identified during medication pass observations involve Rapid-Acting,
Short-Acting and Combination insulin. These insulins start working within a
short time frame and are meant to control blood sugar at meals. Therefore, it
is important that the meal and administration of insulin are appropriately
timed to optimize blood sugar control.
Resources that providers may wish to refer to are:
1) Your Consultant Pharmacist or Certified Diabetes Educator
(exit DHS) [address updated]
3) www.novolog.com (exit
The most frequent insulin administration errors involve rapid-acting and
short-acting insulin. In most cases, these insulins are being administered too
far in advance of a meal. Typically short-acting regular insulin is
recommended to be administered 15-30 minutes prior to eating a meal. Novolog
and Humalog, rapid-acting insulins, are recommended to be administered 0-15
minutes before a meal or immediately after eating a meal.
Individual residents may respond differently to these insulins, due to
their metabolism or absorption of insulin, which may depend on the location of
the injection. If residents do need a greater or shorter time interval between
insulin administration and the meal than what is commonly recommended,
physician orders should specify those requirements.
If alternative administration timing is not ordered, BQA surveyors will
apply the following guidelines:
- 15-30 minutes before a meal, for short-acting regular insulin.
- 0-15 minutes before a meal, or immediately after the meal for Humalog
- Combination products should be administered according to the rapid or
short-acting insulin timelines, depending on which product is in the
If the timing between insulin administration and the meal is outside of
these parameters, the administration of that dose of insulin will be
considered a medication error for purposes of the survey.
If there are further questions please contact Doug Englebert, BQA
Pharmacist at 608-266-5388.
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