Storage and Administration Changes Help Hospital Improve Insulin Safety

Nurses no longer travel with multi-dose vials of insulin because the vials do not leave the ADC area. This has resulted in better storage and accountability for insulin vials. Nurses are also reporting higher rates of satisfaction with the process changes.

The facility noted a spike in insulin purchases in correlation with the hospital-wide implementation of bar-coded medications in September 2008. Medication scan rates with insulin have risen dramatically since the hospital started attaching scannable labels to the insulin vials, and the number of insulin purchases has since dropped. The hospital has also realized an unexpected financial savings, a nice added bonus, says Kerr.

"It wasn't really our purpose, but we ended up saving money in insulin inventory costs. One of the particular brands of insulin is $70 a vial," says Kerr.

Success through collaboration

Kerr insists that this process improvement was only possible because both nurses and pharmacists wanted to improve insulin safety. Nursing is in charge of reporting their monthly scan rates. If one unit's reported scan rate is significantly lower than another's for that month, a member of the pharmacy department goes to the unit to discuss the appropriate process and observe medication workflow.

"You can look at all of the reports you want, but until you go up and talk to nurses and watch how they do it, you're really not in a position to recommend process changes," says Kerr. "We intentionally sent a pharmacist to work with key nurses in key areas." Any fixes to the process came from this collaboration, says Kerr, and not from a top-down practice.

Baystate Health has made it a priority as an institution to engage all relevant staff members in an improvement project to ensure optimal outcomes, says Kerr.

"This is a conscious and intentional method of process management and process improvement, the overall company is spreading this staff engagement phenomenon strategically," says Kerr. The insulin safety project is one example of that philosophy in action.

"When disciplines such as pharmacy and nursing work together to improve processes, the patient is ultimately the winner," says Woods.