A stewardship intervention program for safe medication management and use of antidiabetic drugs

Rui-yi Zhao,1 Xiao-wen He,1 Yan-min Shan,1 Ling-ling Zhu,2 Quan Zhou3 1Clinical Nurse Specialist Section, Division of Nursing, 2Geriatric VIP Care Ward, Division of Nursing, 3Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, Pe...

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Autores principales:	Zhao RY, He XW, Shan YM, Zhu LL, Zhou Q
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	antidiabetic drugs diabetes nursing specialists injection technique insulin medication errors oral hypoglycemic agents pharmacy quality improvements Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/daaaeccc1b3f4eba9348a1fe450af83b
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spelling	oai:doaj.org-article:daaaeccc1b3f4eba9348a1fe450af83b2021-12-02T06:58:47ZA stewardship intervention program for safe medication management and use of antidiabetic drugs1178-1998https://doaj.org/article/daaaeccc1b3f4eba9348a1fe450af83b2015-07-01T00:00:00Zhttps://www.dovepress.com/a-stewardship-intervention-program-for-safe-medication-management-and--peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Rui-yi Zhao,1 Xiao-wen He,1 Yan-min Shan,1 Ling-ling Zhu,2 Quan Zhou3 1Clinical Nurse Specialist Section, Division of Nursing, 2Geriatric VIP Care Ward, Division of Nursing, 3Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China Background: Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team’s integrated endeavors to enhance safe medication management and use of antidiabetic drugs.Methods: A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People’s Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually.Results: The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly “look-alike” and “sound-alike” NovoMix 30® (biphasic insulin aspart) and NovoRapid® (insulin aspart) has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011) to 96% (fourth quarter 2011) (P<0.05). The number of medication administration errors related to insulin continuously decreased from 20 (2011) to six (2014). The occurrence rate of hypoglycemia in non–endocrinology ward diabetes inpatients during 2011–2013 was significantly less than that in 2010 (5.03%–5.53% versus 8.27%) (P<0.01). Percentage of correct management of hypoglycemia by nurses increased from 41.5% (April 2014) to 67.2% (August 2014) (P<0.01). The percentage of outpatient diabetes patients receiving standard insulin injection education increased from 80% (April 2012) to 95.2% (October 2012) (P<0.05). Insulin injection techniques among diabetes outpatients who started to receive insulin were better than indicated in data from two questionnaire surveys in the literature, including the percentage checking injection sites prior to injection (85.6%), priming before injection (98.1%), rotation of injecting sites (98.1%), remixing before use (94.5%), keeping the pen needle under the skin for >10 seconds (99.4%), and using the pen needle only once (88.7%). On-site inspection indicated of great improvement in the percentage of drug-related problems in the antidiabetes regimen between the first and second quarter of 2014 (1.08% versus 0.28%) (P<0.05).Conclusion: Quality improvements in safe medication management and use of antidiabetic drugs can be achieved by multidisciplinary collaboration among pharmacists, nurses, physicians, and information engineers. Keywords: diabetes nursing specialists, injection technique, insulin, medication errors, oral hypoglycemic agents, pharmacy, quality improvementsZhao RYHe XWShan YMZhu LLZhou QDove Medical Pressarticleantidiabetic drugsdiabetes nursing specialistsinjection techniqueinsulinmedication errorsoral hypoglycemic agentspharmacyquality improvementsGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 10, Pp 1201-1212 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	antidiabetic drugs diabetes nursing specialists injection technique insulin medication errors oral hypoglycemic agents pharmacy quality improvements Geriatrics RC952-954.6
spellingShingle	antidiabetic drugs diabetes nursing specialists injection technique insulin medication errors oral hypoglycemic agents pharmacy quality improvements Geriatrics RC952-954.6 Zhao RY He XW Shan YM Zhu LL Zhou Q A stewardship intervention program for safe medication management and use of antidiabetic drugs
description	Rui-yi Zhao,1 Xiao-wen He,1 Yan-min Shan,1 Ling-ling Zhu,2 Quan Zhou3 1Clinical Nurse Specialist Section, Division of Nursing, 2Geriatric VIP Care Ward, Division of Nursing, 3Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China Background: Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team’s integrated endeavors to enhance safe medication management and use of antidiabetic drugs.Methods: A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People’s Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually.Results: The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly “look-alike” and “sound-alike” NovoMix 30® (biphasic insulin aspart) and NovoRapid® (insulin aspart) has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011) to 96% (fourth quarter 2011) (P<0.05). The number of medication administration errors related to insulin continuously decreased from 20 (2011) to six (2014). The occurrence rate of hypoglycemia in non–endocrinology ward diabetes inpatients during 2011–2013 was significantly less than that in 2010 (5.03%–5.53% versus 8.27%) (P<0.01). Percentage of correct management of hypoglycemia by nurses increased from 41.5% (April 2014) to 67.2% (August 2014) (P<0.01). The percentage of outpatient diabetes patients receiving standard insulin injection education increased from 80% (April 2012) to 95.2% (October 2012) (P<0.05). Insulin injection techniques among diabetes outpatients who started to receive insulin were better than indicated in data from two questionnaire surveys in the literature, including the percentage checking injection sites prior to injection (85.6%), priming before injection (98.1%), rotation of injecting sites (98.1%), remixing before use (94.5%), keeping the pen needle under the skin for >10 seconds (99.4%), and using the pen needle only once (88.7%). On-site inspection indicated of great improvement in the percentage of drug-related problems in the antidiabetes regimen between the first and second quarter of 2014 (1.08% versus 0.28%) (P<0.05).Conclusion: Quality improvements in safe medication management and use of antidiabetic drugs can be achieved by multidisciplinary collaboration among pharmacists, nurses, physicians, and information engineers. Keywords: diabetes nursing specialists, injection technique, insulin, medication errors, oral hypoglycemic agents, pharmacy, quality improvements
format	article
author	Zhao RY He XW Shan YM Zhu LL Zhou Q
author_facet	Zhao RY He XW Shan YM Zhu LL Zhou Q
author_sort	Zhao RY
title	A stewardship intervention program for safe medication management and use of antidiabetic drugs
title_short	A stewardship intervention program for safe medication management and use of antidiabetic drugs
title_full	A stewardship intervention program for safe medication management and use of antidiabetic drugs
title_fullStr	A stewardship intervention program for safe medication management and use of antidiabetic drugs
title_full_unstemmed	A stewardship intervention program for safe medication management and use of antidiabetic drugs
title_sort	stewardship intervention program for safe medication management and use of antidiabetic drugs
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/daaaeccc1b3f4eba9348a1fe450af83b
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A stewardship intervention program for safe medication management and use of antidiabetic drugs

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