Insulin use to be focus area for reducing medication harm

Insulin is a key area of high risk medication usage targeted in a new national initiative to prevent medication errors.

The  Australian Commission on Safety and Quality in Health Care has nominated insulin use along with anticoagulants and antipsychotic drugs in one of three  “flagship areas” where it aims to cut medication errors by 50% as part of a WHO-backed initiative.

The Commission has been seeking feedback from clinicians on several options for national action to meet the target by 2025.

In its discussion document “Medication without harm: WHO Global Patient Safety Challenge” released for consultation, the Commission notes that more than 1 million prescriptions for insulin are dispensed every year and there are 28,000 people with diabetes who start using insulin annually.

With the increasing numbers of people with type 2 diabetes using insulin, it says there is a need to review areas such as patient knowledge and skills in managing insulin-dependent diabetes, including self-management .

The document also highlights areas such as clinician knowledge of the risk of harm from insulin, especially in people with suboptimal glycaemic control; clinician communication skills and consumer engagement, and the role of diabetes educators to disseminate usage information for the expanding insulin delivery technologies, and newer formulations

It says that efforts to reduces medication risks with insulin should focus on the three areas of initiation, transition of care and de-escalation.

It cites examples of medication risk initiatives such as the Adjustment for Normal Eating in Australia (OzDAFNE) program that helps patients calculate how much insulin is needed for the amount of carbohydrate eaten. The program also provides advice on how to manage hypoglycaemia, illness and exercise.

“In hospitalised patients, factors such as fasting for surgery or investigations, appetite fluctuations due to nausea and vomiting, and other changes to daily routines while in hospital can affect BGLs. This can lead to potential complications with insulin use and dosing,” the document states.

Rapid developments in glucose monitoring devices and insulin pumps technology present opportunities as well as risks for medication errors, the proposal says.

The Commission says it is now developing proposals based on feedback from clinicians on the questions:

What is considered best practice of what is being done now?

  • What, if anything, should be done more or less of?
  • What are the current gaps in achieving positive patient outcomes to reduce adverse events from poor diabetes and insulin management in the future?
  • What indicators should be used to measure progress towards the 50% reduction targets?

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