Revisiting insulin practices in Galway University Hospitals

Background: Injectable insulin formulations exhibit a notable propensity for errors and can cause significant patient harm when used inappropriately. Aims: The aim was to conduct a second audit on insulin prescribing, administration and glucose monitoring practices in Galway University Hospitals since the initial audit in 2022. Methods: This audit was conducted over one day in June 2023, approved by the local Clinical Audit Committee, piloted on four inpatients, and communicated to all data collectors prior to commencement. Generated data were anonymous and securely stored. Independent analysis was conducted by three researchers to confirm reliability of results. Results: Five hundred and fifty-seven inpatients were reviewed, of whom 21% (116) had diabetes and 10% (56) were prescribed insulin. In total, 94% (265) insulin brand names and 94% (266) dose units were clearly prescribed, 90% (254) administration times were clearly specified by a prescriber, 80% (227) orders were signed, 70% (39) prescribers clearly documented their registration number/bleep/name at least once for contact purposes, 80% (210) administrations were double-checked by a second person, 58% (152) administration times documented by a nurse, and 24% (9) inpatients administered insulin by a nurse when not prescribed. Conclusion: Results have identified an overall practice improvement. High-leverage strategies such as electronic prescribing are a current consideration to standardise practices. All aspects of this review are transferable to other hospitals. Disseminating results and promoting transferable benefits should encourage participation of all Irish hospitals to conduct a standardised national annual insulin audit to improve patient care.