insulin pens help reduce cost or do they?

[rxjunkie]

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I work in a 350 bed hospital . We go thro insulin pens alot. If you go in our patients drawers you find several pens for same patient. Techs have been trained to leave pens in bins when switching carts but still we get tons of missing doses. Any body has any idea how we can control this.

 

[rxlea]

I work in a 350 bed hospital . We go thro insulin pens alot. If you go in our patients drawers you find several pens for same patient. Techs have been trained to leave pens in bins when switching carts but still we get tons of missing doses. Any body has any idea how we can control this.

Does your EMR indicate if something has already been dispensed?

 

[rxlea]

And when you say missing doses, do you mean the nurses say the pen is missing or that doses aren't being administered/charted?

 

[zelman]

Now that humulin products come in 3 mL vials, I wouldn't think pens are money savers.

 

[rph3664]

I think they do in the long run, because they improve compliance.

 

[zelman]

I think they do in the long run, because they improve compliance.

Not in a 350 bed hospital as per the original post

 

[confettiflyer]

I think they do in the long run, because they improve compliance.

pff then you fire the nurse for that one

 

[rxjunkie]

Does your EMR indicate if something has already been dispensed?

Yeah the EMR says pen was dispensed and maybe patient recieved several doses, but now pen turns out missing., so instead of arguing with the RN we generate a label and send another pen. THen two days later the original pen appears somewhere in the patients room.

 

[rxlea]

Well, your supervisor and the nursing supervisor need to discuss this issue, particularly the amount of money you're losing.

1) train techs to place the pen in the bin or whatever set up you have every single time.
2) the pharmacist answering the phone needs to ask the nurse if she/he checked the fridge, the patient's bin, etc. and if she/he says no, indicate you won't print a label until she/he checks.
3) education on this needs to go out to nurses from nursing sup, and to pharmacists from pharmacy sup
4) the amount of dispensed pens (number of labels printed) should be checked against doses-- this is a QI type project. Give it to a student or resident. Depending on your EMR, it might be easy.
5) nurses should not be storing things at the patient bedside. That's a training and accountability issue that needs to be taken care of by the nursing department.
6) this should be a joint effort and may involve a bullet on the agenda for your next staff meeting (and the nurses' staff meeting to)
7) it will take some time, but shouldn't take too much
8) after designated "training period" then it becomes an accountability issue with appropriate consequences, blah blah blah.

Money talks. Find out just how much you're losing. I'm sure nursing head and pharmacy head will be interested to know.

 

[rxlea]

Instead of EMR, you could just have the techs collect all the return to pharmacy pens and calculate it that way.

 

[rxlea]

We added bright green stickers to put on product like inhalers that say "Do Not Store At Patient Bedside" 🙂

 

[rph3664]

pff then you fire the nurse for that one

I meant outpatient and overall.

 

[spacecowgirl]

I hope you're not charging patients for multiple pens.

 

[xiphoid2010]

there is actually somewhat of a backlash against insulin pens. This is due the shocking new discovery that nurses often "borrow" pens to use on multiple patients. I remember reading there are several investigations involving potential exposure of thousands of patients to HIV (or was it hep). Just a heads up.

 

[rxlea]

I hope you're not charging patients for multiple pens.

That was going to be my follow up question.

 

[owlegrad]

there is actually somewhat of a backlash against insulin pens. This is due the shocking new discovery that nurses often "borrow" pens to use on multiple patients. I remember reading there are several investigations involving potential exposure of thousands of patients to HIV (or was it hep). Just a heads up.

How big is the risk? I mean you change the pen needle each time right?

 

[xiphoid2010]

How big is the risk? I mean you change the pen needle each time right?

the pens have a back flow, so it can draw blood back into the pen even if needles are changed. So when nurses "borrow" meds... oh wait, nurses would never do that.

 

[zelman]

How big is the risk? I mean you change the pen needle each time right?

Does the risk % matter? I can give you one of two drugs: one has a 0% risk of giving you HIV and the other has a 0.000001% risk of giving you HIV. Which do you want? I'd go with manufacturer's recommendation on this one.

 

[confettiflyer]

Well hypothetically you can calculate the expected value of reusing insulin pens using a simple model. So if reusing pens cuts your pen usage down by 50% (1 pen for 2 patients) at a WAC of $60/pen, but infecting a patient with HIV will cost your hospital $5M in a settlement, and hypothetically saying that 99.999% of the time there will be no disease transmission:
+$30 x 0.99999 = $29.9997
-$5,000,000 x 0.00001 = ($50)
Expected value: ($20)
So you lose $20 per patient if you reuse a pen needle assuming a 0.001% transmission rate of HIV.

The actual transmission rate is like 0.3% for needle sticks (i'm lazy, used wikipedia, someone else find the real #).

 

[pharmasaur]

we store community insulin vials in the fridge on the floors and all the RNs use those. we have lantus, humulin N, humulin R....and one more I forgot....once the vial is opened it's good for 28 days, it doesn't have to be stored in fridge obviously but the special place is there so the RNs know to get it from there and put it back there. there isn't a big issue with the vials getting lost. if the vial is missing, RNs know to bug other RNs asking who has it. we go through the vials fast so they rarely go over the 28 days.

 

[xiphoid2010]

Well hypothetically you can calculate the expected value of reusing insulin pens using a simple model. So if reusing pens cuts your pen usage down by 50% (1 pen for 2 patients) at a WAC of $60/pen, but infecting a patient with HIV will cost your hospital $5M in a settlement, and hypothetically saying that 99.999% of the time there will be no disease transmission:
+$30 x 0.99999 = $29.9997
-$5,000,000 x 0.00001 = ($50)
Expected value: ($20)
So you lose $20 per patient if you reuse a pen needle assuming a 0.001% transmission rate of HIV.

The actual transmission rate is like 0.3% for needle sticks (i'm lazy, used wikipedia, someone else find the real #).

I was just reminded of a movie I once accidentally watched, revenge of the nerds.

 

[RutgersEMSOP10]

we store community insulin vials in the fridge on the floors and all the RNs use those. we have lantus, humulin N, humulin R....and one more I forgot....once the vial is opened it's good for 28 days, it doesn't have to be stored in fridge obviously but the special place is there so the RNs know to get it from there and put it back there. there isn't a big issue with the vials getting lost. if the vial is missing, RNs know to bug other RNs asking who has it. we go through the vials fast so they rarely go over the 28 days.

The CDC says:

• Insulin Vials: Multi-dose vials of insulin should be dedicated to a single person whenever possible. If the vial must be used for more than one person it should be stored and prepared in a dedicated medication preparation area outside of the patient care environment and away from potentially contaminated equipment. Insulin vials should always be entered with a new needle and new syringe. Needles and syringes should never be used to administer insulin to more than one person and should be disposed of immediately after use in an approved sharps container.

With the Department of Health and Human Service's Partnership for Patients, federal government facilities require the use of one vial per patient. We are in the process of switching from Novolin/Novolog to Humilin/Humalog brand due to the recent availability of 3mL vials due to the waste associated with a 10mL vial per patient with an average length of stay of 2.75 days.

 

[pharmasaur]

what you quoted said that the vial can be used for more than one patient as long as certain criteria are met? im confused. its totally ok to have insulin vials being shared

 

[confettiflyer]

I was just reminded of a movie I once accidentally watched, revenge of the nerds.

you're just jealous at my nerdiness