Enhancing insulin-use safety in hospitals: Practical recommendations from an ASHP Foundation expert consensus panel

Daniel J. Cobaugh, Gregory Maynard, Lebron Cooper, Patricia C. Kienle, Robert Vigersky, Diana Childers, Robert Weber, Stacy L. Carson, Melanie E. Mabrey, Nicki Roderman, Frederick Blum, Rebecca Burkholder, Marcus Dortch, George Grunberger, Daniel Hays, Rashida Henderson, Jeffrey Ketz, Todd Lemke, Surendra K. Varma, Michael Cohen

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


Purpose. Consensus recommendations to help ensure safe insulin use in hospitalized patients are presented. Copyright

Summary. Insulin products are frequently involved in medication errors in hospitals, and insulin is classified as a high-alert medication when used in inpatient settings. In an initiative to promote safer insulin use, the American Society of Health-System Pharmacists (ASHP) Research and Education Foundation convened a 21-member panel representing the fields of pharmacy, medicine, and nursing and consumer advocacy groups for a three-stage consensus-building initiative. The panel's consensus recommendations include the following: development of protocol-driven insulin order sets, elimination of the routine use of correction/sliding-scale insulin doses for management of hyperglycemia, restrictions on the types of insulin products stored in patient care areas, and policies to restrict the preparation of insulin bolus doses and i.v. infusions to the pharmacy department. In addition, the panelists recommended that hospitals better coordinate insulin use with meal intake and glucose testing, prospectively monitor the coordination of insulin delivery and rates of hypoglycemia and hyperglycemia, and provide standardized education and competency assessment for all hospitalbased health care professionals responsible for insulin use.

Conclusion. A 21-member expert panel convened by the ASHP Foundation identified 10 recommendations for enhancing insulin-use safety across the medicationuse process in hospitals. Professional organizations, accrediting bodies, and consumer groups can play a critical role in the translation of these recommendations into practice. Rigorous research studies and program evaluations are needed to study the impact of implementation of these recommendations.

Original languageEnglish (US)
Pages (from-to)1404-1413
Number of pages10
JournalAmerican Journal of Health-System Pharmacy
Issue number16
StatePublished - Aug 15 2013

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy


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