2.  Introduced in 2010 by the National Patient Safety Agency.  Aim to reduce insulin error prescribing and administration and reduce patients deaths.  20% medical negligence claims are medication errors  Claims amount to £750 million a year

3.  The RIGHT insulin  The RIGHT dose  The RIGHT way  The RIGHT time

4. There are over 20 different insulins availablemany with similar names and packaging. With more coming onto the market. InsulinwithSimilar name HumalogwithHumalog Mix 25 Humalog Mix 50 NovorapidwithNovomix 30 Insuman BasalwithInsuman Comb 25 Insuman Comb 50 Insuman Comb 15 Humulin SHumulin I Humulin M3

5.  Insulin passports were introduced to reduce the number of prescribing and dispensing errors. Making patients more aware of the name and packaging of their insulin.  All patient prescribed insulin should have an insulin passport. In nursing and care homes should be with their notes or prescription.

6.  To be kept with MARS sheet  District Nurses to have insulin passport in their notes  Full Name  Date of Birth  NHS Number

7.  Insulin should be prescribed with the dose in full no abbreviations e.g units instead of U or IU.  Insulin comes in prefilled/disposable pens and cartridges with reusable pens and vials.  All should be clearly labelled.  Insulin should not be omitted with out advice from a HCP with experience in diabetes.

8.  Not all cartridges and pens are compatable.  It is always important to check the dose of insulin to be given  Syringes should not be used to withdraw insulin from cartridge  Ensure spare pen device if using cartridges

9.  Insulin should be injected at 90 degree angle.  You can use the abdomen, upper outer thighs and upper outer buttocks as injection sites.  Vary the injection sites to prevent fatty lumps (lipohypertrophy)  Insulin should be mixed (rock and roll)  Change insulin pen needle for each injection  Do not store the needle on the pen.

14.  Insulins have different profiles and modes of action.  Some such as mixed insulins, timing of the injections are important e.g. or Humulin M3 should be given 20mins before meals or Novomix 30 just before eating.  Insulins such as Lantus or Humulin I are usually not given in conjunction with food.

15.  Store unopened supplies of insulin in the refrigerator  Insulin in use can be kept at room temperature but avoid storing in direct sunlight and heat e.g near radiators, window sills etc  Dispose of needles into a yellow sharpsbin  Ensure enough supplies of insulin eg weekends  Dispose of any insulin 30 days after using

16. Six steps of Insulin Safety – Diabetes on the Net Safe Use of Insulin – Virtual College, Patient Safety Suite

17.  FIT4safety (2012) highlighted the need to reduce needle stick injuries inline with EU directive(2010/32)  National guidance was that by 2013 all injections should be given using a safety needle.  Locally it was decided that the BD Autoshield now the BD Autoshield Duo best met the needs of our patients and staff.

18.  Only available in a 5mm length  Reduces risk of intramuscular injections  No need to pinch skin  Compatible with all insulin and GLP-1 pens  Dual protection  Clinicians should be trained before using these needles. Locally or B-D will provide training.

20.  Blood Glucose monitoring informs you what your blood glucose level is doing  Recording blood glucose levels assists in making safe changes to a patients diabetes medication  Blood glucose testing should be agreed as a management plan with diabetes team/patient  Patients taking Insulin or Sulphonylurea should have access to blood glucose monitor

21.  Meter list within Bradford and Airedale  Each patient/resident should have access to their own blood glucose meter  People with Type 1 diabetes have access to a blood glucose and ketone testing meter  Glucomen LX meter, Optium meter, Neo meter

22.  Explain and ensure patient understands procedure  Wash patients hands in soap and water  Ensure meter is prepared to use as per guidelines  Ensure test strips are in date and correct test strips in use  Select finger and area – use side finger  Use single use lancet

23.  Apply blood to strip  Await result and record in patients records  Dispose of sharps and test strip  ?Quality Control meters

24. Every patient should have the correct insulin passport Contact Diabetes team at Horton Park Phone- 01274323226 press 3 Fax- 01274 323738 Following Information Needed Patient Name and DOB Name of Insulin Insulin device Address of Residential or Nursing home 2 passports will be sent 1 must go with patient if admitted to hospital