I visited a patient for medication review and management who was on Insulin. I asked the patient on how you manage your insulin.
She said she is managing well. She has been on insulin for the past five years. Then I asked her if you don’t mind can I check your insulin pens, needles and lancets and show me how you inject insulin. Before I was checking her injecting techniques I checked the needles. I checked the needles which were expired one year ago. The needles were dispensed roughly about 4 years ago. The colour of the box faded. When I checked the needles box there were roughly more than 50 needles in the box. It clearly shows the patient was using one needle for more than one occasion may be for weeks or for months.
When I asked the patient she said nobody told needles has expiry and should be used only once. We can understand the needles were issued roughly 4 years ago but no healthcare professional checked/intervened why this patient not ordering needles (GP or community pharmacy). Shockingly its looks like nobody intervened on her insulin medicines management for the past 4 years.
When I asked her to demonstrate the injection techniques, she was not doing it properly and she was trying to inject just under the skin (intradermal). I asked anybody demonstrated on how to give injection. She said no but its subject for confirmation. She was injecting at the same side on a regular basis and not changing the sites on a regular basis.
I explained everything about medicines management of insulin which includes storing, checking blood sugar levels and disposal of needles and lancets.
I fully demonstrated on insulin administration, changing administration sites, needles to be used only once. Finally I made patient fully aware on how to use insulin safely and effectively. I explained she can’t use the expired needles anymore. I disposed them at the office sharps bin. I ordered new needles through GP practice and collected the needles box from the pharmacy on the first in the Morning on the following day and delivered to the patient and made it ready for the patient for insulin administration on the same day.
It was a very proud moment for me because I was able to do a holistic approach on medicines management and patient safety. It was a great satisfaction of I had an opportunity to become an instrument to transform one of my patient’s life. The patient and the family were so happy and praised me many times and told my colleagues about my inputs.
Learning outcomes.
1. Never assume patient knows everything even though if they say yes. Always check.
2. Attention to detail.
3. Always ask the patient to demonstrate on how to administer insulin.
4. Check the records on prescribing pattern for insulin, needles and lancets to identify whether the patient taking the insulin properly.
5. When the HbA1c was checked last.
6. Checking who is managing her diabetes either GP or diabetic nurse.
7. Signposting to the right team for managing diabetes.
8. Organising medicines ordering and delivering medicines to the patient.
