Can anyone/everyone share with me what your "workhorses" are for insulin in the acute care setting.  We are currently using Apidra for short acting insulin and Lantus for basal.  We also have Levemir as restricted for those patients who cannot use Lantus.  I am interested to see what everyone is using. I would like to switch the Apidra to Novolog.  I appreciate any thoughts, comments and suggestions.

Judy,

My hospital using predominately Lantus and Novolog.  We also have Levemir (rarely used) avasilable, and use NPH as basal in our pregnant patients.   Regular insulin is also used for IV insulin drips.  We also use pens for one, and syringes and vials for the other.

I'm not certain if this was intention to spread our hospital business between all the insulin companies, or if it happened by accident.  I have no idea.

I love Novolog--it's approved for pregnancy, it's approved for pumps and is incredibly stable for patients on pumps.  My Apidra experience is less, but I haven't been thrilled with it in a pump.   it's stability over the three days of infusion set use hasn't been as consistent.  I have no supporting data for this, but have had about a dozen patients independently, and unsolicited, report to me, that their glucose values rose significantly while using Apidra in their pumps.  Coincidently ,all reported the same time frame of 36 to 48 hours.

Donna, thanks for the important info regarding Novolog vs Apidra in pumps

Thanks Donna, I was going to ask what your experience with Apidra in pumps was.  Can you just elaborate for me what is in a pen and what is in a vial?  Currently we use all vials with the exception of Levemir, and the reason for this was that I did not want anyone to confuse Lantus and Levemir so we went for pen form with the Levemir.  We actually have a nice size group of patients on Levemir and so far the pen is working out well. It was our first venture with using a pen, and so far, so good (I probably just jinxed it).  I love Novolog as well and feel it would be better suited here but, as you know, the wheels of change turn oh so slowly!  Thanks for your feedback, I appreciate it because our hospitals are very much alike as far as demographics and bed size!!

Judy,

I'm not sure why, but what exists here now is Lantus with a vial and syringe--most likely because the previous person in my position was never able to do the pen inservices with the RNs prior to her leaving.  We have pens for Novolog, and all the RNs have been inserviced on these.

I'm looking for studies on numbers of insulin errors with pens versus vials.  I suspect there are more errors with vials, but I need the documentation.  We're trying to collect this data from my own institution, but I'm not certain that our culture permits the totally honest reporting of all drug errors or 'near misses', so that I can get an honest perspecitive on this critical issue.

We all know that pens are more costly--to patients and health systems alike.  As well, in a hospital environment, there can be some significant wastage of insulin with pens that can't be used, as vials can, between multiple patients.  Our pharmacy will be very supportive of converting the entire institution to pens, if there is an increase in [patient safety.  These patient safety improvements trump cost.  BUT, I need this documentation.  So if any of you have any studies, that show this please forward.  I've been looking without success, thus far.

Hi Donna,

 I did a quick search for you and here is one article I found.  I will keep looking for others.

http://www.sugarnancy.com/articles/ART0009.pdf

Thanks!

Several years ago, I did a cost comparison between the pens and the vials in the hospital setting. At that time, shared vials were not accepted practice so the pens were actually cost effective because of less waste of insulin. I had an article that looked at the occurence and cost of accidental needlestick injuries but it was on hard copy and I am no longer at that facility. I found that the slide over safety on the syringe was not commonly activated after injections so there was a significant risk for needlestick injury. The safety needle for the pen is an automatic lockout so that virtually eliminates the risk for contaminated needlestick. I do have a hard copy of a June, 2008 release from the American Nurses Association titled Workplace Safety and Needlestick Injuries are Top Concerns for Nurses. A contact listed on the article is mary.mcnamara@ana.org. There web address is www.nursingworld.org. Another resource I would check with is novo nordisk. They have provided me with research articles in the past. Roxy

  Several thoughts about hospital use of insulin.  Apidra is preferred by some for the inpatient population due to the increased time in dosing, 15 min before up to 20 min after the meal.  For nursing staff convenience, yet good control this is a consideration.     Shared vials have been out for awhile.  For those using vials though,  Lilly makes a 3ml vial of Humalog.    Our experience has been less waste of insulin since using pens and nursing staff love them even with the portected needles for instituional use.  For the hospital, we use Lantus and Novolog, but anyone admitted with different programs, we match their needs.

Thank you all for your searches, web site, insights, etc.  Sorry it's taken me days to get back to you.  I was out with a sinus infection but I do appreciate your invaluable insights.  Thanks, again for the help.