News Feature
New findings on the safety of delivery devices for diabetes care
UKHSA begins testing arrivals from China to enhance detection of new variants
An independent research organisation, MindMetre Research, has published the findings of an enquiry on the use of passive safety-engineered devices among NHS Trusts. The enquiry sought to determine whether the use of passive devices may be linked to mis-dosage or non-delivery of insulin. The study found a third of NHS Trusts had experienced instances of mis-dosage or non-delivery of insulin to patients when passive devices were being used. While the EU Directive on Sharps Safety mandates
the use of safety devices, it does not proscribe the type of safety devices to be used. Guidance from the Royal College of Nursing (RCN) notes: “Safety engineered devices have a built in feature to reduce the risk of a sharps injury before, during and after use. Devices can be passive or active. For example, passive devices have an automatic safety mechanism that is activated after use…. An active device needs to be manually activated by the member of staff.” However, despite the freedom of choice between active or passive delivery mechanisms, that is carefully underlined in the legislations and professional association documents, recommendations for the blanket use of passive devices are widespread. Such blanket advice may – in some significant healthcare settings – be misleading. In the context of diabetes administration, the authors of this research report received anecdotal evidence from diabetes specialist nurses in NHS Trusts where two phenomena had taken place: l Insulin pooling on the skin of patients after using passive injection devices, suggesting that the dose had either been under-delivered or not delivered at all
l Instances of diabetics experiencing an adverse event related to misdosage while still in the Unit or on Trust premises
While these anecdotes were of great concern, a scan of official records indicated that there was an absence of precise data around these issues. MindMetre Research therefore made an enquiry to all NHS Trusts in England and Wales, under the Freedom of Information Act 2000, to gain a picture of how widespread these anecdotal experiences might be. The purpose of the enquiry was to provide some initial evidence as to whether diabetes specialist units might need to assess – or re-assess – which type of safety-engineered delivery device is most appropriate for insulin administration to diabetics attending their units. The resulting evidence revealed: l Over a third of Trusts (36.4%) had experienced insulin pooling when using passive devices to administer insulin.
l A quarter (25%) reported that they had experienced misdosage of insulin when using passive devices, evidenced by an adverse related patient event on-premises.
l A handful of Trusts reported that they had switched from passive to active delivery devices because of concerns over patient well-being and the avoidance of mis-dosage.
“Our research has shown that, as with many other areas of care, a one-size-fits-all approach is rarely in the patient’s best interests. It serves to underline that every drug delivery scenario needs to be assessed on its merits when evaluating the balance between patient outcomes and HCP safety – especially around device options and choices where the cost difference is not extreme. “Safety legislation was introduced over a decade ago to protect healthcare professionals from avoidable harm and this is a very good thing. However, the well-being of patients – especially vulnerable or less dextrous patients – is always the key consideration when such choices are being made.”
‘On arrival’ coronavirus (COVID-19) testing aims to help strengthen the UK’s ability to rapidly detect potential new variants circulating in China. The programme will offer swabs to perform PCR tests to up to 20% of arrivals from selected flights. Positive tests will then be sent for sequencing and analysis. Anyone offered a test is encouraged to take it up, though this testing is not mandated for arrival. Samples will be processed by existing UK Health Security Agency (UKHSA) testing laboratories. Passengers will receive their test results via text or email. Positive samples will go on for genomic analysis for detection of variants. If a positive test is returned, passengers will be advised to follow existing UKHSA guidance, living safely with respiratory infections. In order to gather further genomic data,
UKHSA has also asked NHS services to identify any patients hospitalised with COVID-19 who have a travel history which includes China in the preceding 14 days. All positive samples from hospitalised patients with this travel history will be prioritised for sequencing. Any sequences obtained will be analysed for new or emerging variants and also be uploaded rapidly onto open access databases, including GISAID, so that the UK can continue to contribute to global health knowledge and security.
New design for CSJ launched
The team at CSJ are delighted to present readers with a fresh new design for 2023. We hope you like the changes and welcome your feedback. You can share your views with the editor at:
louiseframpton@stepcomms.com We also welcome your thought-leadership, educational insights, news, and case studies. Sharing best practice and celebrating success stories from the frontline has never been more important, as the sector strives to recover during these challenging times. Please send a synopsis of your ideas for a contributed article to the editor, or simply let us know what you would like to read more about in the journal by connecting with us on Linked In.
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