Make A Point Of Preventing Insulin Pen Errors

Compared with administration of insulin with a vial and syringe, patients often prefer pen devices, because of their ease of use and improved dosing accuracy.1 However, up to 75% of patients with diabetes do not administer or store insulin pens according to manufacturer recommendations.2 Improper use of pens can increase dosing errors, insulin degradation or expiration, and the risk of infection. Therefore, periodic education from health care professionals on how to correctly use pen devices is imperative for patients with diabetes.

Pen Device Errors

Preparing for Administration

Remind patients to attach a new needle before administering insulin. The results of one study show that 16% of patients reported leaving the needle attached to the pen device for 3 or more injections. Needle reuse can bend or break the tip and decrease lubrication, resulting in a more painful injection. In addition, it can lead to insulin contamination, lipohypertrophy (LH), and a loss of sterility. Once a new needle is attached, educate patients about appropriately removing needle caps. Some needles use a single outer cover (eg, auto shield) while other brands require the removal of 2 covers to expose the needle. In one published case, a provider discovered that a patient was removing the outer but not the inner cap, resulting in no insulin delivery for 6 months.

Additional errors may occur, because of skipping the priming step or dialing the incorrect dose. Priming the device after attaching a new pen needle ensures that the pen works correctly and air bubbles are removed, which improves insulin dose accuracy. Yet, more than two-thirds of patients are not aware of the reason for priming and often skip this step. Visually impaired patients also may rely on audible clicks to dial up the dose. However, sound recordings show that certain pen devices produce louder clicks than others and make patients unsure as to whether they have selected the correct dose. In addition, with the availability of concentrated insulins in pen devices, it is important to properly educate individuals about the concentration that is delivered with each click.

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