Nursing staff should be advised by trusts not to extract insulin from the pen devices or cartridges commonly-used by patients with diabetes, due to the risk of “harm and death”.
NHS Improvement said, compared to insulin syringes, the use of pen-shaped devices for subcutaneously injecting insulin has increased as they made it easier for patients to self-inject.
“Organisation should warn staff that extracting insulin from pen devices or cartridges is dangerous”
The regulator noted that although the strength of insulin was previously standardised at 100 units/mL, it could vary in pen devices, currently by multiples of 100 units/mL.
NHS Involvement has issued a warning over situations where health professionals have tried to help patients to use their device and ensure the correct dose in the wrong way.
Where this has happened, NHS Improvement said it was aware of patient safety incidents involving staff using insulin syringes and needles to extract insulin directly from pen devices or refill cartridges.
It highlighted that insulin syringes have graduations only suitable for calculating doses of standard 100 units/mL.
If insulin extracted from a pen or cartridge is of a higher strength, and that is not considered in determining the volume required, it can lead to a significant and potentially fatal overdose.
While only a small number of low and no-harm reports of this type have been identified, NHS Improvement said its networks “confirmed that the practice appears to occur more widely”.
Extracting insulin from pen devices also risks damaging the device’s mechanism and will not be covered by the manufacturer’s warranty, said the regulator.
The regulator noted that staff may be using a syringe and needle to withdraw insulin because they did not have access to equipment for safely disposing of needles attached to pen devices.
As pen devices are typically only used by patients, they were not routinely supplied with safety-engineered needles, NHS Improvement said.
If staff feel it will protect them from needlestick-injury, they “may resort” to using an insulin syringe and needle, it said, adding that staff may also lack skill or confidence in using pen devices.
“Organisation should warn staff that extracting insulin from pen devices or cartridges is dangerous and should not happen,” said the regulator’s patient safety alert.
It added: “Organisations should ensure staff are trained and competent in using insulin pens and that training is available.
“Staff, and where appropriate, patients who use pen devices, should be routinely provided with safety needles and access to equipment capable of safely removing and disposing of used insulin pen needles,” said the alert.