30 minutes or less

When it comes to correctional insulin administration in the hospital, the old adage, “Better late than never,” is simply unsafe. Timeliness is important concerning the critical interval between checking a patient’s blood glucose (BG) reading and administering correctional insulin for the result. As the population living with diabetes in America grows, so does the number of people admitted to the hospital with diabetes as a comorbidity. Current best-practice recommendations guide hospitals to use insulin for diabetes management while patients are in the hospital. Insulin is a high-risk medication, with potential for serious harm or even death when errors occur. A 2010 study revealed that the most-common medical errors in critical care patients were insulin administration errors.1 A survey conducted by the Institute for Safe Medication Practices (ISMP) in 2014 surveyed pharmacists and nurses, and showed that subcutaneous insulin ranked ninth among almost 40 drugs and drug classes identified as highalert medications that concerned practitioners.2 Yet, of all the highalert medications, subcutaneous insulin came in last place when pharmacists and nurses were asked to rank how confident they were regarding the effectiveness of hospital-wide precautions to prevent serious errors.2 The survey findings suggest a consensus among pharmacists and nurses that hospitalized patients are vulnerable to errors with subcutaneous insulin, and that more must be done to prevent patient harm with this high-alert medication. Many insulin errors result in serious hypoglycemia, especially when point-of-care BG monitoring is not coordinated well with meals and insulin therapy. Coordinating insulin with meals and glucose monitoring in inpatient settings is a nationwide challenge.3 Studies suggest that the timing of glucose monitoring and insulin administration occur within an acceptable range less than half of the time in hospitalized patients prescribed insulin.4,5 Studies suggest that less than half of patients met the goal of receiving a rapid-acting insulin within 10 to 15 minutes of a meal, and only 35% received glucose monitoring within 1 hour prior to insulin administration.4,5 Timing for meals, BG testing, and rapid-acting insulin administration varied significantly and was not well synchronized among the various facilities. Coordinating BG monitoring with correctional insulin administration is a significant challenge in the inpatient hospital setting. BG checks were performed at inconsistent times on the authors’ unit; insulin was not being administered in coordination with BG checks, and the staff was unaware of the ISMP recommendations. This article outlines an intervention aimed at reducing the interval between BG checks and correctional insulin administration, with a target of 30 minutes or less of the BG check as per ISMP best-practice recommendations.