Hospitals asked to rethink use of insulin pens

A big issue that a couple of New York hospitals have been dealing with is notifying patients that they may have been exposed to HIV, hepatitis B or hepatitis C through the improper sharing of insulin pens.

It was announced early this year that over 700 patients at a Buffalo, New York Veterans Affairs Hospital were placed at risk. Another New York hospital also announced possible exposure of more than 2,000 patients due to improper sharing of pens among inpatients. In a blog last year, I mentioned similar cases where thousands were affected in Texas and Wisconsin. We've also received multiple additional reports involving smaller numbers of patients.

Insulin pens were originally introduced for use by patients in the home or wherever they travel. They offer convenience and may help prevent certain types of medication errors. But they really weren't developed for routine hospital use. That's what's happened though, and serious problems have occurred. Serious enough that the nonprofit I work for, the Institute for Safe Medication Practices (ISMP) is calling for hospitals to closely reexamine their policies regarding insulin pen devices, with the thought of transitioning away from insulin pens for routine inpatient use.

Diabetic patients who inject insulin often find it convenient to use one of the small injectors that look like a pen and contain a cartridge of insulin. They make it easy for insulin-dependent patients to inject the drug accurately. All you do is change the needle each time you need to give yourself an injection, dial in the dose you need, prepare the site, and inject.

Reuse happens when a hospital worker uses a pen on one patient, then changes the needle and uses the same pen to inject another patient, never realizing that studies have shown a risk of infection when insulin pens are reused for more than one patient, since blood and tissue can travel back into the cartridges after injection. With a constant shift of new and temporary workers staffing hospitals, it's been difficult for some of them to control with 100% effectiveness exactly how pens are used.

The U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) caution insulin pen users to remove the needle immediately after injection and warn against sharing the device between patients. But despite educational efforts and monitoring by hospitals, reports of patients placed at risk of infection continue to surface.

Based on the risks associated with reusing insulin pens on multiple patients, some hospitals never transitioned to using them while others have reverted back to using vials of insulin instead. Most recently the Veterans Health Administration (VA) National Center for Patient Safety prohibited use of multi-dose pen injectors on patient care units at VA facilities, with only a few exceptions, which ISMP supports.

We hope that the ongoing safety issues with insulin pens will lead to recognition that lack of understanding regarding their safe use is more widespread than initially thought, and cannot be easily solved with education alone or fairly dealt with by punishing individuals who have never learned the correct way to use these devices. We believe that the risk of patient infection is best mitigated by removing insulin pens from use in inpatient settings.

The Center for Disease Control and Prevention says that over 150,000 patients have been impacted by unsafe injection practices since 2001, exposing them to illnesses like hepatitis and HIV, or bacterial infections. Last year the CDC launched a"One & Only Campaign" to educate people about safe injections: one needle, one syringe, only one time.