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Insulin and Patient Safety - time for prefilled syringes
- David K Whitaker, M13 9WL (2 April 2009)
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David K Whitaker, Consultant Anaesthetist Manchester Royal Infirmary, M13 9WL
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One of the Patient Safety First Campaign’s objectives is ‘Reducing harm from high risk medicines’ including insulin. Since its discovery in 1922 insulin’s administration has saved, prolonged and improved millions of patients’ lives but because insulin is such a powerful and effective medication whenever human errors are made in its administration they are likely to lead to patient harm. Other similarly vital but high risk medications are potassium and heparin. Over the years there have been many patient deaths and harm from incorrect administration of insulin but these have markedly reduced and the history of insulin development is a lesson in patient safety itself, although the final steps still need to be taken. In the 1970s a whole series of different strengths of insulin were available 120 units per ml, 80 units per ml and 60 units per ml, and the opportunities for calculation errors were immense. Fortunately these were all standardised to the current 100 units per ml concentration which is now the only one available and at a stroke this removed the need for many of the former and hazardous calculations. Also at that time insulin came from several different sources e.g. cows, pigs and individual patients could have immunological interactions if the pharmacist inadvertently supplied cow insulin to a patient who had been used to pig insulin. The development and widespread use of recombinant human insulin in the 1980’s again removed that sort of patient harm. A subcutaneous injection of a small volume of insulin is all that is often required and so again development of a standard insulin syringe that can be accurately used for small volumes in a regular way was developed. Insulin however continues to be available in large multidose ampoules from which it can still be drawn into conventional, and in these circumstances, less safe syringes. A recent example of this appears, from the press reports, to be the sad death of Mrs. Thomas in Gwent (1) and surely the time has come for insulin only to be available in pre-filled syringes containing single patient doses as is already the case for modern preparations of subcutaneous heparin. Evidence on the advantages of pre-filled syringes for both patients and nursing / medical staff was recently presented at the Health Select Committee enquiry into Patient Safety (2) and certainly in 2009 this final step should now be taken. David Whitaker FRCA, FFPMRCA, Hon FCARCSI
Ref 1: http://news.bbc.co.uk/1/hi/wales/south_east/7964341.stm Ref 2: http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/uc151- i/uc15102.htm Competing interests: None declared |
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