Clinical update

Diabetes: preparation of insulin syringes for home use

Guidance highlights issues that must be addressed in pre-loading insulin syringes for later use by someone with diabetes
Picture shows a bottle of insulin and a syringe

Guidance highlights issues that must be addressed in pre-loading insulin syringes for later use by someone with diabetes

Essential information

More people than ever have diabetes, with the charity Diabetes UK estimating that by 2025 more than 5 million people could have the condition.

Around 90% have type 2. Everyone with type 1 diabetes and some with type 2 needs to take insulin.

While innovative solutions have meant more people with diabetes who need insulin can find an insulin pen delivery device that suits them, for a small number this is not possible.

    ...

    Guidance highlights issues that must be addressed in pre-loading insulin syringes for later use by someone with diabetes

    Diabetes: preparing an insulin syringe for home use
    Picture: Alamy

    Essential information

    More people than ever have diabetes, with the charity Diabetes UK estimating that by 2025 more than 5 million people could have the condition.

    Around 90% have type 2. Everyone with type 1 diabetes – and some with type 2 – needs to take insulin.

    While innovative solutions have meant more people with diabetes who need insulin can find an insulin pen delivery device that suits them, for a small number this is not possible.

    Reasons for being unable to use an insulin pen include poor manual dexterity, visual impairment, an inability to find a device that fits their needs, or a reluctance to switch from a familiar standard insulin injection syringe.

    As a result, these patients remain unable to autonomously inject once or twice a day, requiring nursing support to pre-load insulin syringes so they can maintain independence.

    What’s new?

    In January, the RCN published the fourth edition of its guidance on Advanced Preparation of Insulin Syringes for Adult Patients to Administer at Home.

    The updated guidance has been developed for nursing practitioners working in a variety of settings. It highlights the professional, organisational and safety issues that must be addressed when pre-loading insulin syringes for later use by a person with diabetes.

    The RCN says community nurses are under increased pressure to undertake the pre-loading of insulin syringes for people with diabetes to administer at home. However, it believes this is not best practice.

    It is regarded as necessary for only a small number of patients, and should only be considered as a final option after all others have been exhausted. It is vital that practitioners are aware of all the potential legal and safety complexities beforehand, the RCN says.

    In essence, pre-preparing insulin syringes is an unlicensed activity that falls outside the Medicines Act (1968). As such, practitioners and health organisations must take responsibility for its safety.

    Among the RCN’s key recommendations is that nurses should operate within the framework of a local pre-loaded insulin syringe clinical policy. This should detail the responsibilities of everyone involved, including the employing organisation, the patient, the GP and the community nurse.

    It should also standardise how nurses perform the preparation of syringes. The policy should be regularly updated by the local diabetes lead nurse and the medicines management team.

    How you can help your patients

    Patients must be assessed and have full capacity for this practice to be considered, the RCN advises. They should also be frequently and routinely reassessed.

    A senior diabetes specialist nurse should be involved in the initial assessment, with risk assessments updated regularly.

    Patients must accept full responsibility for the storage and administration of insulin-filled syringes. They should receive full training and education in their specific medication, including the dose, frequency and injection technique.

    Expert comment

     Samantha Kelly, diabetes nurse consultant for Central London Community Healthcare NHS Trust

    Samantha Kelly, diabetes nurse consultant for Central London Community Healthcare NHS Trust

    ‘In the past this was a more routine practice for community nurses, as insulin pens weren’t as good, but it’s less common now.

    ‘As nurses, we always want to help our patients, so there can be a tendency to act first and think about other issues later. But we are firmly saying you can’t do that because this is an unlicensed activity.

    ‘There must be an agreed protocol and policy in place at the outset, to ensure patient safety and protect the individual nurse.

    ‘The document includes an example policy that we’re happy for people to use as a blueprint. We’re not promoting this as best practice and it should only happen if all other avenues have been exhausted.

    ‘But for the small number of patients who aren’t able to administer their own insulin and have full capacity, this gives them quality of life.’


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