Safety advisory highlights use of insulin pumps, CGM systems during hospitalization
The Joint Commission announced its new Quick Safety advisory, “Safe patient use of insulin pumps & CGM devices during hospitalization,” which addresses how hospitals can safely implement patient use of these personal devices for their hospitalized diabetic patients.
Approximately 34.2 million, or just over one in 10, Americans have diabetes. Many of these individuals rely on personal insulin pumps and continuous glucose monitoring (CGM) systems to improve their overall glycemic control and reduce the risk of experiencing hypoglycemic or hyperglycemic episodes. When hospitalized, the desire to continue using personal pumps or CGM systems can present safety and quality risks.
As outlined in the advisory, safety actions to consider include:
· Policies and procedures. When developing policies, procedures, education and training surrounding use of a personal device, organizations should have representation from multiple disciplines including nursing, pharmacy, risk management and physician leadership.
· Home medication usage. Patients may prefer to use their own insulin that is brought from home to the hospital. Organizations should define under what circumstances medications brought in by the patient or family may be used and implement a process to identify and visually evaluate the medication’s integrity.
· Medication self-administration. When an organization permits a patient to self-manage their insulin administration via a personal infusion device, a written process should guide safe and accurate self-administration of the medication.
· Orders. Insulin dosages and glucose monitoring frequency. As with all medication, an insulin order from the licensed practitioner is required. Policies that address the type of medication orders permitted and the required elements of medication orders should address self-administered medication via an infusion device.
· Medical record documentation. When the organization determines where and how the safe use of a personal medical device is documented within the patient record, such documentation should be comprehensive to include medication dose, frequency and route of administration, patient response to treatment and more.
· Education of staff, patient and family. Patients and families should receive education on applicable policies and procedures. This education should be based on the learning needs assessment, taking into consideration any treatment and/or environmental factors that may be a barrier to safe self-administration.
· Conducting a risk assessment. When developing policies and procedures around self-administration of medications via an infusion device, organizations should conduct a risk assessment to identify risks associated with various options being considered.
The advisory also includes a list of resources from the American Diabetes Association, Centers for Disease Control and Prevention, U.S. Food & Drug Administration and others.
