Addressing safety concerns about U-500 insulin in a hospital setting.

PURPOSE Safety precautions for the use of U-500 insulin in a hospital setting are described. SUMMARY St. Vincent Indianapolis Hospital, a 500-bed community hospital, formed a committee to develop a U-500 insulin policy to address the unique considerations required for this drug at all steps of the medication management process. An order set was designed by the multidisciplinary team to standardize prescribing and ensure safety measures are consistently applied. Home dose verification by a pharmacist or certified diabetes educator is required to avoid inaccurate dosing. U-500 insulin is not stocked or stored in the automated dispensing machines on the nursing unit. When an order for U-500 insulin is received, a two-pharmacist order-entry process unique to this drug is followed. The total dose in units is entered, and the computer converts the dose to volume. A pharmacist checklist and dispensing kit are stored with the product to ensure that all safety precautions have been completed. A pharmacist hand delivers the insulin to the charge nurse and bedside nurse, at which time a safety time-out is taken to review the key characteristics of the drug, the physician order, and the medication administration record. Tuberculin syringes are used to administer U-500 insulin, and patients are taught how to use this syringe. Staff members also receive education regarding the U-500 insulin policy and procedure. CONCLUSION Safety precautions for hospital use of U-500 insulin employed a multilayered, multidisciplinary process using safeguards at every step in the medication management process.