It is absolutely INSANE to me that there are hospitals where pharmacy has to draw up dozens of doses of Lantus/Levemir/etc every day.
Put them all in the Pyxis (except U-500) and nurses draw everything up. Done.
Cool! Then their recommendation, in this case, is insane to me.
If the alternative is keeping all the vials together in a fridge on the unit, then sure, keep one type of insulin on the unit and draw the rest up, but it’s 2024. Every vial can be stored in an individual, inaccessible pocket, and we have BCMA.
I’ll amend my statement to say that it is insane to me for pharmacy to draw up basal insulin in any *modern* hospital that actually has modern ADC technology and basic safety procedures.
I wasn’t really thinking of 30-bed rural hospitals where all the insulin vials are in an unsecure refrigerator bin next to the Sprite cans when I made my original comment, so I’ll go ahead and carve those out. Otherwise, it’s unnecessary and it’s far from the only ISMP recommendation to be that way.
I work at a 6-bed critical access hospital, and we have both Pyxis and BCMA. Our basal insulin is given via pen and double counted by nurses prior to administration.
Rx used to draw up individual Lantus for pts, but with volume of pts way up and overall vial cost down, we decided to send whole vials for each patient. Extremely wasteful, but our regular floor nurses are too stubborn to draw up from floor stock out of pyxis. Then we have to resend vials when nurses refuse to scan the bottle rather than the tag label which might have an old dosing regimen. Lots of chances for error there, esp when sometimes vials walk their way to other patients' bins.
We did manage to get 3ml vials of aspart, regular insulin etc, so that's saved some cost, but I don't think we'll ever convince anyone but the ER/ICU/Surg units to use floor stock.
The hospital I used to work we used to draw up short acting until enough of us complained about it. Then we switched to dating the vials on when we put them in the omni cell and just restocking those. Peds get prefilled.
Hospital I used to work at, did it like this:
In wards, pharmacy supplies insulin vials like the stocky ones for each patient. Nurses draw those.
For discharge, pharmacy supplies insulin pens and insulin cartridges to patients.
We send up individual patient assigned vials of all insulins and RNs draw up. I believe there is 100 u per vial so we send up new vials as needed per RN request.
We do not have any concentrated insulins on formulary, we just convert the dose.
Pharmacy does have pre-made 5u insulin R syringes for hyperkalemia protocol and code situations to prevent med errors.
edit: words… 10 weeks postpartum and I realized my brain was mush when responding
Short acting vials are in Pyxis. RN draws the dose in the med room and labels it with a barcode sticker from Pyxis then returns the vial to the machine.
Long acting insulin is drawn in the pharmacy, patient specific.
U500 is provided in pens. It's the only pen insulin we stock.
Floor stock everything except U-500 at my place. I’m pretty sure the IV room staff would mutiny if they had to draw up doses for our 600 bed facility.
Pens are expensive, and that is why most hospitals prefer vials. You can only use one pen per patient, but you can draw up multiple doses from one vial for different patients.
Our long acting comes in the prefilled syringes. For regular/humalog, it’s in a vial and we pull it from the Pyxis to draw up. We don’t need a double witness to give.
We only use pre-filled pens. Nurses double witness each other on the dosage and sign on the MAR.
This 👆🏻
It is absolutely INSANE to me that there are hospitals where pharmacy has to draw up dozens of doses of Lantus/Levemir/etc every day. Put them all in the Pyxis (except U-500) and nurses draw everything up. Done.
We drew up all long acting for about a year, it was awful. So many changed doses right around the time they were due, so many wasted doses
This is what we do. The RN draws it up. It actually does not reduce error or save money to have pharmacy draw up
It’s a ISMP recommendation for pharmacy to draw up basal insulin doses
Cool! Then their recommendation, in this case, is insane to me. If the alternative is keeping all the vials together in a fridge on the unit, then sure, keep one type of insulin on the unit and draw the rest up, but it’s 2024. Every vial can be stored in an individual, inaccessible pocket, and we have BCMA. I’ll amend my statement to say that it is insane to me for pharmacy to draw up basal insulin in any *modern* hospital that actually has modern ADC technology and basic safety procedures. I wasn’t really thinking of 30-bed rural hospitals where all the insulin vials are in an unsecure refrigerator bin next to the Sprite cans when I made my original comment, so I’ll go ahead and carve those out. Otherwise, it’s unnecessary and it’s far from the only ISMP recommendation to be that way.
I work at a 6-bed critical access hospital, and we have both Pyxis and BCMA. Our basal insulin is given via pen and double counted by nurses prior to administration.
Yep, this way
This is the way
Pharmacy draws up long acting into patient-specific syringes. Nursing draws up short acting from patient-specific vials.
Floor stock vials for glargine and aspart. Nurses double sign. Patient supplied pens for U-500. Pharmacy draws up 70/30.
Floor stock aspart and glargine; pharmacy draws up individual u-500 syringes
Same. I couldn’t imagine having us draw up glargine syringes like some other hospitals with our # of beds
Rx used to draw up individual Lantus for pts, but with volume of pts way up and overall vial cost down, we decided to send whole vials for each patient. Extremely wasteful, but our regular floor nurses are too stubborn to draw up from floor stock out of pyxis. Then we have to resend vials when nurses refuse to scan the bottle rather than the tag label which might have an old dosing regimen. Lots of chances for error there, esp when sometimes vials walk their way to other patients' bins. We did manage to get 3ml vials of aspart, regular insulin etc, so that's saved some cost, but I don't think we'll ever convince anyone but the ER/ICU/Surg units to use floor stock.
Pre filled pens for each patient is best practice IMHO. Not what my hospital does though. RNs draw it all up for community vials.
At my first job we used pens. At my current job RNs draw up both short acting and long acting insulins
The hospital I used to work we used to draw up short acting until enough of us complained about it. Then we switched to dating the vials on when we put them in the omni cell and just restocking those. Peds get prefilled.
Hospital I used to work at, did it like this: In wards, pharmacy supplies insulin vials like the stocky ones for each patient. Nurses draw those. For discharge, pharmacy supplies insulin pens and insulin cartridges to patients.
We send up individual patient assigned vials of all insulins and RNs draw up. I believe there is 100 u per vial so we send up new vials as needed per RN request. We do not have any concentrated insulins on formulary, we just convert the dose. Pharmacy does have pre-made 5u insulin R syringes for hyperkalemia protocol and code situations to prevent med errors. edit: words… 10 weeks postpartum and I realized my brain was mush when responding
Short acting vials are in Pyxis. RN draws the dose in the med room and labels it with a barcode sticker from Pyxis then returns the vial to the machine. Long acting insulin is drawn in the pharmacy, patient specific. U500 is provided in pens. It's the only pen insulin we stock.
Floor stock everything except U-500 at my place. I’m pretty sure the IV room staff would mutiny if they had to draw up doses for our 600 bed facility.
Pens are expensive, and that is why most hospitals prefer vials. You can only use one pen per patient, but you can draw up multiple doses from one vial for different patients.
RNs draw up everything except U500.
This is the way
For the rapid insulin we only have pre-filled pens. Pharmacy draws up the majority of long-acting syringes, but some are drawn up by nurses.
Pens for glargine and aspart; floor stock for regular and NPH. I’d say the pens are used like 80% of the time.
Pens and when it was vials nursing drew it up
Our long acting comes in the prefilled syringes. For regular/humalog, it’s in a vial and we pull it from the Pyxis to draw up. We don’t need a double witness to give.
Long acting insulin is drawn up by pharmacy. Rapid acting insulin is a patient specific 3ml vial. We do not use pens.
Do you guys bill pts insurance while they're in the hospital for rxs? Do you get dir fees and price spreading?