Background: Insulin is considered a high-alert medication due to frequent prescription or administration errors and severe adverse events. Insulin prescription errors during hospital discharge may lead to increased re-admissions and increased emergency department visits. We analyzed the frequency of patients discharged on insulin pens with and without an associated prescription for pen needles.
Methods: Patients discharged from Emory Hospitals, from January 01, 2016 to December 31, 2016, with at least one prescription for insulin pens were included. Patients with prescriptions for pen needles alone or for insulin vials were excluded. Only one prescription for insulin pens per patient was included and paired with pen needles, when available. De-identified data was collected from the electronic medical record. We compared clinical characteristics of patients discharged on insulin pens with and without an associated pen needles prescription.
Results: Among 580 patients discharged on insulin pens, mean age was 58 years (± 16), 50.2% were male, and 58.5% were African-American. Most patients had Medicare insurance (47.4%), were admitted to medicine services (86.2%), and were discharged on a basal-bolus insulin regimen (46%), followed by basal insulin alone (33.6%). Notably, only 195 patients (33.6%) had an associated prescription for pen needles at discharge. Patients on basal insulin alone and on a basal-bolus regimen were significantly more likely to be discharged without an associated prescription for pen needles, 77.4% vs 22.6% (p<0.01) and 55.1% vs 44.9% (p<0.01), respectively.
Conclusions: We found that up to 66% of patients discharged from our hospitals with insulin pens do not receive an associated prescription for pen needles. Patients discharged on basal or basal-bolus insulin represent a high risk group. Future quality improvement projects are required to improve a safe discharge process for patients with diabetes treated with insulin.
.png)
.png)