Avoiding problems with insulin pens in the hospital.

travel through the patient’s skin and into the nurse’s finger, which is holding the pinched skin. Along with misalignment of the angle of injection, it may be difficult to visualize the injection site during pen delivery of insulin. Poor visualization has been reported as a contributing factor with this type of needlestick injury. Some insulin pen needles are not available with a needle guard; this can present another potential source of needlestick injury after the injection has been given. Although a needle guard might not prevent injury during administration, as when pinching the patient’s skin together, it can prevent exposure to a contaminated needle after the injection. Errors in technique. Nurses have reported seeing a “wet spot” on the skin after injection and thought that the spot might be insulin. They worried that the patient might not have received the full dose, particularly because they could not visualize the medication as it was delivered. In some cases, the wet spots left at the injection site turned out to be a very small amount of insulin residue left on the skin as a result of priming the pen before injection. In other cases, the wet spots involved substantial amounts of insulin. The plungers or buttons of some pens are difficult to push down, making it easy to accidentally lift the needle out of the skin when delivering the insulin, thus leaving a wet spot. Insulin can also leak out of the injection site if the needle is not left in for about 6 seconds after the insulin is injected; this can be another source of a wet spot. As another example, the nurse or patient might not tip and roll insulin suspension (e.g., NPH, insulin mixtures) pens for proper mixing before use. This can result in large clumps of aggregated insulin flowing from the pen during the first injection, followed by subtherapeutic doses in subsequent injections. Using the pen like a vial. The wide Mr. Grissinger is Director of Error Reporting Programs at the Institute for Safe Medication Practices in Horsham, Pa. (www.ismp.org). Avoiding Problems With Insulin Pens In the Hospital