R Zaidi, A Heald, P Wai, T Patani and S Westal: Diabetic Medicine 2011

An audit on insulin prescribing errors and a survey of junior doctors on insulin prescribing

Diabetic Medicine, March 2011, vol./is. 28/(87-88), 0742-3071 (March 2011)

Authors: R Zaidi, A Heald, P Wai, T Patani and S Westal – Diabetes and Endocrine Department, East CheshireNHS Trust, Macclesfield, UK

Aims: (1) To identify errors in prescribing insulin on medical and surgical wards and compare resultswith those of the National Inpatient Diabetes Audit (NIDA) 2009. (2) A survey assessed the confidence of junior doctors in prescribing insulin.

Methods: We conducted a prospective audit, analysing 31 insulin prescription charts on medical and surgical wards, over 2 weeks following the NPSA report on safe administration of insulin. ‘Units’ written, regimen type and legitimacy, timing and signatures were checked. 48 junior doctors were questioned. This included 19 specialist registrars, 16 F2/CT trainees and 13 F1 doctors.

Results: ‘Units’ were written in the majority of charts (80.6 per cent). Those without (19.4 per cent) had either ‘IU’ or ‘U’ written. The regimens were legitimate in nearly all (96.7 per cent) which included basal-bolus (35.4 per cent), twice daily (35.4 per cent), once only longacting insulin analogue (22.5 per cent) and other regimes (3.2 per cent). The majority of the drug charts had correct timing (71 per cent) and were signed by the prescriber (93.5 per cent). In total, nearly half (45.1 per cent) of drug charts analysed had some errors. This was higher than the previous year’sNIDA results (32 per cent), the national average for prescription errors being 19 per cent. The majority of junior doctors (68.5 per cent) were not confident in prescribing insulin for an insulinnaive patient without supervision and all (100 per cent) felt the need for further training. The majority (58 per cent) felt they needed both teaching and practical experience.

Conclusion: Errors in insulin prescription are occurring at a high percentage at our hospital, calling for a need for a regular practical update programme for doctors.

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