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Last Login: 3/31/2009 10:03:08 AM
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| Our institution is still struggling with Humulin U-500 Regular Insulin. From the standpoint of medication safety, we admire those institutions who have limited the storage of vials and preparation of U-500 dosages to the Pharmacy. Some limit the use of the concentrated product to doses over 100 units or daily doses over 200 units. Some specify that only tuberculin syringes may be used for this product and that the doses should be labeled in terms of units and mls. U-500 is often reserved for scheduled doses only. All of these are good ideas. There is much resistance to these practices in our area. The patients use insulin syringes at home and often describe their doses in terms of the unit markings on the insulin syringe. For example, "I use 50 units of U-500" really means the patient measures to the 50 unit mark on an insulin syringe, delivering 250 units of insulin. Some physicians perpetuate this thinking because "that is what the patients understand." We have even had inpatient orders based on the same thinking. This has led to documented errors. The practice of Pharmacy Preparation has not gained acceptance at our institution because some patients may use U-500 in their supplemental regimens, thus requiring immediate turnaround that is not practical in our distribution system. In addition, this requires that physicians make daily dosing changes in time to allow for Pharmacy preparation, a limitation prescribers prefer to avoid. We appreciate information we have received from Beth Israel in Boston and from TIHH in Indianapolis. Is there anybody else out there who has struggled to provide customer satisfaction without sacrificing patient safety and come to a workable policy and procedure for U-500? Christine Pittman RPh WakeMed, Raleigh, NC
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Last Login: 8/25/2009 1:10:20 PM
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| One possibility that comes to mind is to send up a whole vial with the patient name on it that is kept in the drawer. We send up one vial per patient on all our insulins. Also, if you require that all doses of insulin be double checked by a second nurse (as we do here) instead require the double check to be done by a nursing supervisor when the strength is the u-500. Most hospitals have a nursing supervisor on all shifts. I would use insulin needles only.
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