© 2012 Eli Lilly and Company

Prescribing information can be found on last slide

Be Insulin Aware Insulin Safety Cards and Patient Information Booklet update

UKHMG00609 : June 2012

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Introduction: Focus on patient safety

Insulin is a life-saving drug

Insulin administration is an area where correct use is vital to ensure patient safety

Safety is a priority for every healthcare professional and a concern of patients

This is why the Patient Safety First Campaign www.patientsafetyfirst.nhs.uk was launched by the NHS Institute for Innovation & Improvement, the National Patient Safety Agency (NPSA) and the Health Foundation:

“Making the safety of patients everyone's highest priority1”

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1. NHS, High risk meds. Available at: http://www.patientsafetyfirst.nhs.uk/Content.aspx?path=/interventions/High-riskmedication/. (Accessed June 2012)

.UKHMG00609 : June 2012

The Patient Safety First Campaign also focused on reducing the risk of harm from high-risk medicines including insulin.1

Introduction: Focus on patient safety

Lilly is dedicated to patient safety and wants to help ensure the appropriate prescription and administration of its insulin products. This slide kit has been developed in support of the Patient Safety First Campaign.

1. NHS, High risk meds. Available at: http://www.patientsafetyfirst.nhs.uk/Content.aspx?path=/interventions/High-riskmedication/. (Accessed June 2012)

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Ensuring safety throughout the patient journey

To ensure patient safety at all stages of the patient journey, Lilly introduced.... Prescribe right

Dispense right

Inject right

Be Insulin Aware!

Right insulin, right dose, right way and right time

. Lilly DiabetesCompany Confidential© 2009 Eli Lilly and Company

Background to NPSA alert

“Between August 2003 and August 2009 the NPSA received 3,881 wrong dose incidents involving insulin. These included one death and one severe harm incident due to 10 times errors from use of abbreviation of the term ‘unit.”

NPSA case reports: Administration errors in the acute setting2

• 2 deaths related to use of IV syringe rather than insulin syringe– (Junior medical staff were unaware that 1ml of insulin measured in IV

syringe did not correlate to 1 unit dose)• Patient given 0.8mls of mixed insulin instead of 8 units• Medical staff prescribed 6 units soluble insulin, 0.6mls given• Insulin infusion via syringe driver required 0.5mls insulin in 49.5mls

normal saline, 5mls was drawn up and added

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2. National Patient Safety Agency. Rapid Response Report NPSA/2010/RRR013: Safer administration of insulin supporting Information. Available at: http://www.nrls.npsa.nhs.uk/alerts/?entryid45=74287(Accessed June 2010.)

UKHMG00609 : April 2012

. Lilly DiabetesCompany Confidential© 2009 Eli Lilly and Company

NPSA case reports2: Administration errors in the community setting

• A patient’s husband rang to say his wife's blood glucose was 16mmol/l, and he needed to give rapid acting insulin which was supplied on discharge. The hospital had not sent any needles and syringes, so the healthcare assistant was asked to take some. She took syringes and brown needles. The wrong syringe was used and, as a result the patient was given 800 units (8mls) instead of 8 units.

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2. National Patient Safety Agency. Rapid Response Report NPSA/2010/RRR013: Safer administration of insulin supporting Information. Available at: http://www.nrls.npsa.nhs.uk/alerts/?entryid45=74287(Accessed June 2010.)

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NPSA case reports2: Administration errors from abbreviation of insulin units

Case 1 A patient on the GP unit was prescribed 10units of long-acting analogue. At

midday two qualified nurses checked the medication chart and both read it as 100 units; this dose was then administered. The patient became ill and was transferred to the acute trust where her blood sugar level was recorded as 0.5. Hypostop was administered and blood sugar levels recorded at 8.4 and then 12. Patient died in A / E department at 0400hrs. Doctor recorded that death was Left Ventricular Failure and not secondary to the overdose. Pathologist and Coroner informed by the acute trust.

Case 2 Patient fitted and had a hypoglycaemic event, became aggressive and

confused, blood glucose 3.1mmol/l, patient had been given 44 units of intermediate acting insulin instead of 4u as prescribed.

2. National Patient Safety Agency. Rapid Response Report NPSA/2010/RRR013: Safer administration of insulin supporting Information. Available at: http://www.nrls.npsa.nhs.uk/alerts/?entryid45=74287(Accessed June 2010.)

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NPSA alert :NPSA/2010/RRR013 included the following recommendation:2

A training programme should be put in place for all healthcare staff (including medical staff) expected to prescribe, prepare and administer insulin. An e-learning programme is available from3:

www.diabetes.nhs.uk/safe_use_of_insulin

2. National Patient Safety Agency. Rapid Response Report NPSA/2010/RRR013: Safer administration of insulin supporting Information. Available at: http://www.nrls.npsa.nhs.uk/alerts/?entryid45=74287(Accessed June 2010.)3. NHS Diabetes, Safe Use of Insulin, available at: http://www.diabetes.nhs.uk/safe_use_of_insulin (Accessed June 2012)

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The key focus of the Lilly Be Insulin Aware campaign is to check before you inject insulin:-

• Right insulin: Check the name.

• Right dose: Check strength and how much insulin to give. Check the numbers very carefully.

• Right time: With food? At bed time? • Right way: Via syringe, pen or pump?  

Lilly’s Be Insulin Aware Campaign

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NPSA alert: NPSA/2011/PSA003 resulted in the following recommendations5:NHS organisations should ensure that by 31 August 2012:1. Adult patients on insulin therapy receive a patient information

booklet and an Insulin Passport to help provide accurate identification of their current insulin products and provide essential information across healthcare sectors.

2. Healthcare professionals and patients are informed how the Insulin Passport and associated patient information can be used to improve safety.

3. When prescriptions of insulin are prescribed, dispensed or administered, healthcare professionals cross-reference available information to confirm the correct identity of insulin products.

4. Systems are in place to enable hospital inpatients to self-administer insulin where feasible and safe.

4. National Patient Safety Agency. Patient Safety Alert NPSA/2011/PSA003: The adult patient’s passport to safe use of insulin available at: http://www.nrls.npsa.nhs.uk/resources/?EntryId45=130397 (Accessed June 2012)

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NPSA Resources:

A patient information booklet and insulin passport4. http://www.nrls.npsa.nhs.uk/resources/?EntryId45=130397

A shorter version of the booklet is available and can be printed from the NPSA and Leicestershire Diabetes websites5

http://www.leicestershirediabetes.org.uk/582.html

4. National Patient Safety Agency. Patient Safety Alert NPSA/2011/PSA003: The adult patient’s passport to safer use of insulin available at: http://www.nrls.npsa.nhs.uk/resources/?EntryId45=130397 (Accessed June 2012)5. . NHS Diabetes, The Safe Use of Insulin and You, available at: http://www.leicestershirediabetes.org.uk/582.html) (Accessed June 2012)

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NPSA: Patient information booklet and insulin passport

Shorter version of the patient information booklet5

NPSA Patient information booklet4

NPSA generic insulin passport 4

(Folds to credit card size)

4.NHS, The adult patient’s passport to safer use of insulin, available at: http://www.nrls.npsa.nhs.uk/resources/?EntryId45=130397 (Accessed June 2012)5. NHS Diabetes, The Safe Use of Insulin and You, available at: http://www.leicestershirediabetes.org.uk/582.html (Accessed June 2012)

Reproduced with permission from NHS Commissioning Board Special Health Authority

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Pharmaceutical company resources

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Insulin Safety cards are available for Eli Lilly, Novo Nordisk and Sanofi Aventis insulins, which have been agreed by the NPSA as suitable alternatives to the passport6.– The original Lilly insulin safety cards have been updated.

However, organisations should record on their risk registers if these are being used instead of the NPSA tools

It is the responsibility of the prescriber to give out the passport/insulin safety card and the patient information booklet. This includes when initiating insulin and giving

repeat prescriptions6

6. NHS, Implementation of the Insulin Passport, available at: http://www.diabetes.nhs.uk/safe_use_of_insulin/implementation_of_the_insulin_passport / (Accessed June 2012)

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Updated Humalog® (insulin lispro) family safety cards – now meet NPSA insulin passport requirements

Humalog Humalog Mix 50 Humalog Mix25

KwikPen

Cartridge

Vial (New)

KwikPen

Cartridge

Vial (New)

KwikPen

Cartridge

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Updated Humulin® (human insulin) family safety cards – now meet NPSA insulin passport requirements

Humulin M3 Humulin S Humulin I

KwikPen

Cartridge

Vial (New)

Cartridge(New)

Cartridge

KwikPen

Vial (New)

Vial (New)

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Guidance for use of the patient information booklet

Give to the patient and encourage patients to read it.

Explain that several insulins have similar names and this leaflet highlights that mistakes can be made in the prescribing, dispensing and administration of their insulin

If working in GP practice, record the appropriate Read code in the patient’s notes: – Insulin alert patient information booklet given 8CE01 – Professional judgement not to engage patient with insulin

alert requirements 8IF.– Insulin alert patient information booklet information discussed

671F0– Bring to patient’s attention the Patient Information Leaflet

included with their insulin

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Guidance for use of company insulin safety card

Select the appropriate insulin safety card for the correct insulin AND device Give to the patient and ask them to carry at all times and use it to check they

have the correct insulin when receiving a prescription, when insulin is dispensed, or in situations when insulin is being given to them by another person

Advise the patient to destroy any old cards they have

Record that the card has been given. Read codes are:– Insulin passport given 8CE02– Insulin passport completed 8BAi.– Informed dissent not to carry insulin passport 8BAj.

If correct insulin safety card not available:– Give the NPSA generic insulin passport and complete the details for the

insulin(s) and device prescribed

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The ‘Be Insulin Aware’ campaign – Patient resources

The Lilly insulin safety cards are available:-– As stand that includes the ten most frequently

prescribed Lilly insulin presentations or – As boxes of individual Lilly insulin presentations.

In an Emergency Cards– For patients who have diabetes and take insulin. – These are credit-card sized.– Contain emergency advice for patients who are

suffering from a hypo. – There is also space for emergency contact details.

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The ‘Be Insulin Aware’ campaign – Patient resources

Patient Self Management Plan and Diary– Available for Humalog, Humalog Mix25, Humalog Mix50,

Humulin I and Humulin M3 For use in a specified regimen (i.e. b.d., tds)

– Colour coded patient diary includes a photograph of the insulin the patient has been prescribed and

safety information regarding this insulin Top tips for a healthy lifestyle, sick day rules, HbA1c – what is it,

plus much more.

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The ‘Be Insulin Aware’ campaign Healthcare professional resources

Insulins Safety Range Chart, includes:– Insulin Type– Insulin Profile– Insulin Packaging and colour coding

Insulin Letter Template:– Designed to be downloaded (from

www.lillydiabetes.co.uk) and printed on NHS

headed paper to provide information about our

Humalog family of insulins and highlight the

importance of insulin safety.- Can be sent to appropriate individuals, eg.

local pharmacists or hospital inpatient staff.

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Further Information Resources and Patient Leaflets

A selection of further patient leaflets and information resources, many now available in 6 different languages:

For more information and to download a wide range of free materials, visit www.lillydiabetes.co.uk or contact Lilly’s Customer Care on (01256) 315000

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Summary: Be Insulin AwareWhen prescribing, dispensing and injecting insulin

Prescribers (specialists, GPs)

Dispensers (pharmacists)

Advice for the patient prior to injection

Be familiar with the insulin you prescribe

Ensure the patient knows what has been prescribed and how to take it correctly

Ensure others can easily identify what has been prescribed

Ensure you understand what has been prescribed

Ensure hospital personnel receive what has been prescribed and understand how to administer it correctly

Ensure the patient receives what has been prescribed and understands how to take it correctly

Ensure your patients know what they have been prescribed

Ensure your patients check that they receive what they have been prescribed

Ensure your patients know how to inject what they have been prescribed in the right way

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Appendix

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