Suggest an improvement
/* “function”==typeof InitializeEditor,callIfLoaded:function(o),initializeOnLoaded:function(o)(document.addEventListener(“gform_main_scripts_loaded”,()=>gform.scriptsLoaded=!0,gform.callIfLoaded(o)),document.addEventListener(“gform/theme/scripts_loaded”,()=>gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)),window.addEventListener(“DOMContentLoaded”,()=>gform.domLoaded=!0,gform.callIfLoaded(o))),hooks:action:,filter:,addAction:function(o,r,e,t)gform.addHook(“action”,o,r,e,t),addFilter:function(o,r,e,t)gform.addHook(“filter”,o,r,e,t),doAction:function(o)gform.doHook(“action”,o,arguments),applyFilters:function(o)return gform.doHook(“filter”,o,arguments),removeAction:function(o,r)gform.removeHook(“action”,o,r),removeFilter:function(o,r,e)gform.removeHook(“filter”,o,r,e),addHook:function(o,r,e,t,n)null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+”_”+d.length),gform.hooks[o][r].push(tag:n,callable:e,priority:t=null==t?10:t),doHook:function(r,o,e)var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r)return o.priority-r.priority),o.forEach(function(o)”function”!=typeof(t=o.callable)&&(t=window[t]),”action”==r?t.apply(null,e):e[0]=t.apply(null,e))),”filter”==r)return e[0],removeHook:function(o,r,t,n)var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e)return!!(null!=n&&n!=o.tag),gform.hooks[o][r]=e)});
/* ]]> */
-
N/AFix spelling/grammar issueAdd or fix a linkAdd or fix an imageAdd more detailImprove the quality of the writingFix a factual error
-
You don’t need to tell us which article this feedback relates to, as we automatically capture that information for you.
-
This allows us to get in touch for more details if required.
-
Enter a five letter word in lowercase
#gform_wrapper_38 .gform_footer visibility: hidden; position: absolute; left: -100vw;
-
This field is for validation purposes and should be left unchanged.
/* = 0;if(!is_postback)return;var form_content = jQuery(this).contents().find(‘#gform_wrapper_38’);var is_confirmation = jQuery(this).contents().find(‘#gform_confirmation_wrapper_38’).length > 0;var is_redirect = contents.indexOf(‘gformRedirect(){‘) >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery(‘html’).css(‘margin-top’), 10) + parseInt(jQuery(‘body’).css(‘margin-top’), 10) + 100;if(is_form)jQuery(‘#gform_wrapper_38’).html(form_content.html());if(form_content.hasClass(‘gform_validation_error’))jQuery(‘#gform_wrapper_38’).addClass(‘gform_validation_error’); else jQuery(‘#gform_wrapper_38’).removeClass(‘gform_validation_error’);setTimeout( function() /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery(‘#gform_wrapper_38’).offset().top – mt); , 50 );if(window[‘gformInitDatepicker’]) gformInitDatepicker();if(window[‘gformInitPriceFields’]) gformInitPriceFields();var current_page = jQuery(‘#gform_source_page_number_38’).val();gformInitSpinner( 38, ‘https://geekymedics.com/wp-content/plugins/gravityforms/images/spinner.svg’, true );jQuery(document).trigger(‘gform_page_loaded’, [38, current_page]);window[‘gf_submitting_38’] = false;else if(!is_redirect)var confirmation_content = jQuery(this).contents().find(‘.GF_AJAX_POSTBACK’).html();if(!confirmation_content)confirmation_content = contents;jQuery(‘#gform_wrapper_38’).replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery(‘#gf_38’).offset().top – mt);jQuery(document).trigger(‘gform_confirmation_loaded’, [38]);window[‘gf_submitting_38’] = false;wp.a11y.speak(jQuery(‘#gform_confirmation_message_38’).text());elsejQuery(‘#gform_38’).append(contents);if(window[‘gformRedirect’]) gformRedirect();jQuery(document).trigger(“gform_pre_post_render”, [ formId: “38”, currentPage: “current_page”, abort: function() this.preventDefault(); ]); if (event && event.defaultPrevented) return; const gformWrapperDiv = document.getElementById( “gform_wrapper_38” ); if ( gformWrapperDiv ) const visibilitySpan = document.createElement( “span” ); visibilitySpan.id = “gform_visibility_test_38”; gformWrapperDiv.insertAdjacentElement( “afterend”, visibilitySpan ); const visibilityTestDiv = document.getElementById( “gform_visibility_test_38” ); let postRenderFired = false; function triggerPostRender() if ( postRenderFired ) return; postRenderFired = true; gform.core.triggerPostRenderEvents( 38, current_page ); if ( visibilityTestDiv ) visibilityTestDiv.parentNode.removeChild( visibilityTestDiv ); function debounce( func, wait, immediate ) var timeout; return function() var context = this, args = arguments; var later = function() timeout = null; if ( !immediate ) func.apply( context, args ); ; var callNow = immediate && !timeout; clearTimeout( timeout ); timeout = setTimeout( later, wait ); if ( callNow ) func.apply( context, args ); ; const debouncedTriggerPostRender = debounce( function() triggerPostRender(); , 200 ); if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) const observer = new MutationObserver( ( mutations ) => mutations.forEach( ( mutation ) => if ( mutation.type === ‘attributes’ && visibilityTestDiv.offsetParent !== null ) debouncedTriggerPostRender(); observer.disconnect(); ); ); observer.observe( document.body, attributes: true, childList: false, subtree: true, attributeFilter: [ ‘style’, ‘class’ ], ); else triggerPostRender(); } );} );
/* ]]> */
This administering insulin guide provides a step-by-step approach to administering insulin using a pen in an OSCE setting. This should not be used as a guide to administering insulin to actual patients without first consulting your local medical school or hospital guidelines and undertaking the necessary training.
Insulin pens are medical devices used to deliver subcutaneous insulin for the management of diabetes. They are designed to make insulin administration more convenient and accurate compared to traditional syringes and vials.
Gather equipment
Gather the appropriate equipment:
- Clean procedure tray
- Prefilled insulin pen
- Insulin pen needle
- Gauze swabs
- Sharps container
- Prescription chart
Check that all equipment is in date, sterile where applicable, and the packaging is dry and undamaged.
You do not routinely need PPE for insulin administration unless the health worker’s skin is NOT intact (e.g. through eczema, or cracked or dry skin) or if the patient’s skin is NOT intact (e.g. through eczema, burns, or skin infections).1
Introduction
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Introduce yourself to the patient, including your name and role.
Confirm the patient’s name, date of birth and hospital number, and check this against the wristband (in a hospital setting) and medication administration record.
Ask the patient to confirm any allergies.
Briefly explain what the procedure will involve and the rationale using patient-friendly language: “I am here to administer your insulin using an insulin pen. This is important management for your diabetes to help ensure your blood glucose levels are maintained within a normal range. This will involve an injection under the skin. You may briefly experience a sharp scratch as the needle is inserted.”
Briefly explain any risks associated with the procedure: “The procedure does involve some risks, which include bleeding, bruising, a persistent lump at the injection site and a small chance of infection or serious allergic reaction.”
Check the patient’s understanding of the medication being administered and if they have any questions or concerns.
Gain consent to proceed with administering insulin.
Adequately expose the planned injection site. Recommended injection sites include the:
- Abdomen (avoid injecting within a 2-inch radius around the umbilicus)
- Lateral or posterior aspect of the lower part of the arm
- Thigh under the greater trochanter
- Upper buttock2
Position the patient so that they are comfortable.
Ask the patient if they have any pain before continuing with the clinical procedure.
Injection site and skin checks
Ask if the patient has a preferred injection site and where they had their last injection. It is essential to rotate the injection site to prevent lipohypertrophy (hardening of the skin due to fatty lumps).2 Lipohypertrophy results in inconsistent absorption of insulin, potentially leading to hyperglycaemia or hypoglycaemia.
The patient’s skin should be free from any signs of infection, skin lesions, swelling, hardness, inflammation, scars, birthmarks, and bony prominences.2
Final checks
Before proceeding, check and verbalise the seven rights of medication administration.
1. Right person: ask the patient to confirm their details and then compare this to the patient’s wristband (if present) and the prescription. You should use the name, date of birth, and hospital number or address.
2. Right drug: check the labelled drug against the prescription and ensure the medication hasn’t expired
3. Right dose: check the drug dose against the prescription to ensure it is correct
4. Right time: confirm the appropriate date and time to administer the medication and check when the patient received a previous dose if relevant
5. Right route: check that the planned route is appropriate for the medication you are administering
6. Right to refuse: ensure that valid consent has been gained before medication administration
7. Right documentation of the prescription and allergies: ensure that the prescription is valid and legible, and check the patient isn’t allergic to the medication you will administer.
If any of the above information is missing, incorrect, or unclear, it is not a valid prescription. You should not proceed and must escalate the issue to the prescriber immediately.
Safety considerations
Before administering insulin, it is also important to:
- Confirm the patient’s most recent capillary blood glucose. Insulin should not be administered if the blood glucose is less than 4 mmol/L.
- Confirm the patient has access to food and remind them to eat within 20-30 minutes following the adminstration of insulin.
Administering insulin
Insulin should be administered at room temperature, as injecting cold insulin straight from the fridge can be painful.
1. Wash your hands again.
2. Attach the sterile insulin pen needle to the insulin pen.
3. Prime the insulin pen to remove air and ensure the correct dose is administered.
- Set the dose to 2 units and hold the pen vertically
- Press the injection button until insulin is visible at the needle tip
4. Set the prescribed dose of insulin.
5. If the patient has minimal subcutaneous tissue, gently pinch a layer of subcutaneous tissue.
6. Warn the patient that they will experience a sharp scratch.
7. Insert the needle quickly and firmly at a 90° angle with the needle tip within the subcutaneous tissue layer. Ensure the dose window is visible.
8. Inject the set dose by firmly holding the pen and pressing the injection button.
9. Wait and count 10 seconds before removing the insulin pen.
10. Remove the insulin pen and release the skin pinch (if used).
11. Remove the needle from the insulin pen and dispose of it immediately into a sharps container.
12. Apply gentle pressure to the injection site with a gauze swab. Avoid massaging the site.
13. Return the patient’s clothing and bed sheets.3
Skin cleansing
WHO does not recommend the routine use of alcohol-based cleansing wipes before the administration of subcutaneous medication, as this can predispose an individual to develop hardened skin at the injection site.1-2 If the skin is visibly soiled, it should be cleaned with soap and water.
In older patients and those who are immunocompromised, skin preparation using an alcohol swab (2% chlorhexidine gluconate in 70% isopropyl) may be recommended.2
To complete the procedure…
Explain to the patient that the procedure is now complete.
Thank the patient for their time.
Dispose of your PPE and other clinical waste into an appropriate clinical waste bin.
Wash your hands.
Document the details of the procedure and the medication administered, including the date, time and your signature.
Post administration advice
Advise the patient to be aware of signs of hypoglycaemia, including sweating, trembling, anxiety, confusion, tachycardia, tingling lips, blurred vision, dizziness, hunger and pale skin.4
Remind the patient to eat within 20-30 minutes of insulin administration.
Insulin pen storage should follow the manufacturer’s guidelines and should be kept out of direct sunlight and away from radiators.
References
- World Health Organization. WHO best practices for injections and related procedures toolkit. 2010. Available from: [LINK].
- The Royal Marden NHS Foundation Trust. The Royal Mardsen Manual of Clinical and Cancer Nursing Procedures. 10th Edition. Oxford: Wiley-Blackwell.
- Diabetes UK. Injecting Insulin. 2022. Available from: [LINK].
- NHS. Side effects of short-acting insulin. 2023. Available from: [LINK].
Discover more from Bibliobazar Digi Books
Subscribe to get the latest posts sent to your email.
