Patient safety
suggesting that the dose had either been under- delivered or not delivered at all. The second was instances of diabetics experiencing an adverse event related to misdosage while still in the Diabetes Unit or on Trust premises. MindMetre then conducted a review of official
records to corroborate this anecdotal evidence. However, this indicated an absence of precise data relating to adverse events following insulin administration specifically with a passive device. An FOI request was therefore made to all NHS Trusts in England and Wales in order to gauge the extent of these issues. The purpose of this was to gain some initial evidence to establish whether diabetes specialist units might need to assess – or re-assess – the appropriateness of the safety-engineered delivery devices used to administer insulin to diabetics attending their units. The request comprised two questions: whether Trusts had experienced insulin pooling when using passive delivery devices, and whether their diabetic patients had experienced adverse events following insulin administration with a passive device, as a result of suspected misdosage.
Research findings In response to the first question, over a third of Trusts (36.4%) stated that they had experienced insulin pooling when using passive devices to administer insulin. With regard to the issue of possible misdosage of insulin when using passive devices, evidenced by an adverse related patient event on-premises, one quarter (25%) of respondents reported that they had experience of this occurring. In addition to the Trusts unable to answer the questions of the enquiry (11.4% for insulin pooling; 18.2% for adverse events as a result of suspected misdosage), around half of those who said that they had not experienced the issues in question gave somewhat vague and indefinite answers, such as: “With the
appropriate training put in place following introduction we have no evidence of insulin pooling”; “From the data that was searched, no records matching the specific criteria of the question were found”; “The Trust has found no evidence to reflect such instances during the noted period.”
Given the simple, straightforward nature of the questions asked, around an issue of potential patient well-being, the enquiry could have been processed simply by asking the specialist diabetes unit in the Trust; these indirect, elusive answers therefore raise further questions. Furthermore, a selection of respondents reported staff concerns over the use of passive safety devices leading to a policy change, with one Trust commenting, “We stopped using passive safety needles more than five years ago…because we had previously experienced these problems…”. Another noted that they had observed both inaccurate insulin dosage and pooling of insulin with passive safety needles, leading them to move to active safety needles.
Conclusions While there is a clear preference for passive drug delivery devices in the majority of clinical
and care contexts, the evidence suggests that a one-size-fits-all policy is not the best approach and may, in some cases, be undermining the clear clinical duties of patient wellbeing. It is important that every drug delivery scenario is assessed on its own merits when assessing which device is most appropriate – especially in a context where the cost difference is not extreme. Given the findings outlined in this article,
Trusts would do well out to carry out further investigations – particularly given the high proportion of indeterminate and vague responses to the enquiry – and, if necessary, revisit delivery device policies in order to consider whether the balance between healthcare worker safety and patient well-being is best served by the continued use of passive devices, or whether a switch to active devices (in line with existing policy change at a number of Trusts) should be evaluated. The full report on MindMetre’s Freedom of Information request into the use of passive and active safety devices in diabetes administration can be downloaded at:
https://tinyurl.com/whyv34kw
CSJ
References 1 Official Journal of the European Union. (2010). Council Directive 2010/32/EU of 10 May 2010 implementing the Framework Agreement on prevention from sharp injuries in the hospital and healthcare sector concluded by HOSPEEM and EPSU.
Eur-lex.europa.eu/LexUriServ/LexUriServ. do?uri=OJ:L:2010:134:0066:0072:EN:PDF
2 Royal College of Nursing. (2017). Essential Practice for Infection Prevention and Control. Accessed at:
www.rcn.org.uk/-/media/ royal-college-of-nursing/documents/ publications/2017/november/pub-005940.pdf
3 International Organization for Standardization. (2013). ISO 23908:2011 Sharps injury protection.
https://www.iso.org/standard/50680.html
4 Elder, S. NHS Lanarkshire. (2005). Safer Sharps Devices An Evaluation of Utility in NHS Scotland. Accessed at:
www.sehd.scot.nhs.uk/
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