Intended for healthcare professionals

Rapid response to:

Practice Safety Alerts

Safer administration of insulin: summary of a safety report from the National Patient Safety Agency

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c5269 (Published 13 October 2010) Cite this as: BMJ 2010;341:c5269

Rapid Response:

More robust interventions are needed to reliably improve patient safety

Sir,

Lamont et al [1] draw attention again to the very important patient
safety issue of insulin prescribing. Their recommendations are, however,
disappointing. As they themselves recognise, training and education are
the weakest interventions to improve patient safety [2]. Yet all their
suggestions are aimed at trying to change individuals' behaviour.

Until we direct our efforts to improve patient safety towards changes
that introduce robust systems and procedures that provide protection for
the patients and the staff caring for (in this instance computerised
prescribing might be one part of the solution) them human errors will
remain a threat through out healthcare.

Iain Yardley

1- Lamont T, Cousins D, Hillson R et al. Safer administration of
insulin: summary of a safety report from the National Patient Safety
Agency. BMJ 2010 341:c5269; doi:10.1136/bmj.c5269

2- Woodward HI, Mytton OT, Lemer C et al. What have we learned about
interventions to reduce medcial errors? Annu Rev Public Health 2010;31:479
-97.

Competing interests: No competing interests

26 October 2010
Iain E Yardley
Specialist Registrar Paediatric Surgery, formerly Clinical Advisor to WHO Patient Safety
Alder Hey Children's Hospital, Liverpool