Self administration of insulin is promoted at Addenbrookes with an aim of improving the insulin safety. Self administration of insulin can help to prevent harm to patients from wrong dose, wrong insulin and omitted and delayed doses of insulin. It is also integral to ensuring a positive inpatient experience for patients dependent on insulin.
Addenbrookes hospital has made significant progress in promoting insulin self administration for inpatients during the past year. Encouraging patients to Self administer insulin is a recommendation of the NHS Diabetes document ‘Safe and Effective use of Insulin in Hospitalised Patients’ issued in March 2010 and is also highlighted in the NHS Institutes ‘think glucose’ campaign which the Trust is actively participating in.
The team, consisting of nurses, pharmacists, clinicians and dieticians, therefore decided to focus on increasing the number of patients given the opportunity to self administer their own insulin by ensuring the Trust had robust procedures for Self Administration of Medicines (SAM) and improving the awareness of frontline staff.
They used the methodology of small scale change, initially focusing on a specialist Diabetic ward where an audit was conducted and used as a baseline for all future work. Trust Policies and procedures were updated and ratified by relevant Trust Committees and then made available to all staff by placing them on the Trust Intranet “connect”.
To increase the number of patients that were assessed suitable for self administration of insulin the Trust decided to have two levels of SAM patients. Level 1 patients are those that have been assessed as suitable for self administration of insulin only, and level 2 patients administer all medications themselves.
The team are now working on increasing awareness of SAM across the Trust which has been very successful. Related SAM documentation has been highlighted as an area that requires some further concentrated work. SAM has not yet been rolled out across this large Trust but excellent progress is being made towards a goal of making the whole Trust available for SAM where appropriate.
Patients have provided very positive feedback to the roll out of SAM in the Trust. Deborah, a patient on the diabetic ward explained how important self administration of insulin was to her hospital experience, “I would feel very indignant if my insulin was taken away from me and told that I was not allowed to administer the insulin myself. I would feel that I wasn’t trusted to do something that I routinely do when I’m not in the hospital.”
Deborah explained how when she was admitted into the hospital she was quite unwell and so was put onto a sliding scale for the first few days, but felt confident to take over the administration of her insulin as soon as the diabetes team decided she could come off the sliding scale. She explained that being admitted into a hospital makes you automatically feel very out of control, especially when you are acutely unwell, but having the ability to self administer gives you back a degree of control that is really important to the patient experience.
Jane the specialist diabetes nurse explained how useful self administration was for patient who are newly diagnosed. Observation of patient administered insulin allowed for assessment of technique in a controlled environment. This is particularly important for increasing confidence in those patients new to self injecting. Debroah also explained how a hospital admission where the responsibility of self administration is taken away from the patient can be a huge dent in a patients confidence.
A senior nurse on the diabetic ward praised self administration of insulin, “ it is so important for insulin dependent diabetics to be able to continue to have control of their insulin regimen. Getting the insulin to a patient at the correct time is so vital and we can often be so busy that having patients being able to administer themselves means that we can make sure they are not waiting on us”.