Insulin errors and contributing factors affecting people with diabetes in hospital: A scoping review

Background

Whilst insulin therapy errors are commonly reported in hospital and can cause significant negative outcomes for people with diabetes, there is no standardised approach to identifying when and why these errors occur within complex inpatient settings.

Objective

This scoping review was conducted to explore and map the types and classification of reported insulin errors in the care of people with diabetes in hospital inpatient settings and to identify potential interacting components/factors associated with these errors.

Research design and methods

The review followed the methodological approach of the Joanna Briggs Institute for scoping reviews. Published and unpublished literature (grey) in the English language were searched from January 2000 to July 2024 on Medline, CINAHL, Embase and other relevant websites. Eligible studies were those reporting insulin errors occurring in hospital during the treatment of people who had diabetes. A new framework was developed for examining insulin errors (RESILIENT - interacting-components-in-insulin-use-in-hospital). This was applied to categorise incidents and interacting components identified. Results were summarised graphically and descriptively.

Results

A total of 124 peer-reviewed publications and reports were included. Only forty-nine studies attempted to classify the type of errors reported and they varied considerably in terminology and focus. Insulin errors were most frequently reported at the prescribing, administration, communication/documentation and medication review stages. Common factors associated with reported insulin errors included: time-critical coordination of insulin related tasks (for example coordination of glucose monitoring, meal delivery and mealtime insulin administration; prescribing and medication review; intravenous insulin infusion management); capability at point of care, staff knowledge, non-adherence to guidelines/recommendations; teamwork, communication gaps or errors; patient factors; organisational processes/systems, education and training; equipment (e.g. lack off system integration, right equipment at point of care).

Conclusions

The review highlighted considerable heterogeneity in approaches to identifying and classifying insulin errors in the literature. This review identified incidents occurring in areas of the insulin process which have been previously rarely explored. Further studies are needed, using standardised approaches which capture the complexity of insulin errors within the hospital system, to support the development of interventions which improve insulin safety. Use of RESILIENT Framework could offer a more standardised method of data collection and analysis of insulin errors.

Registration

The protocol was registered at the Centre for Open Science (https://osf.io/nmd8a).

Social media abstract

A novel approach to identifying, classifying & exploring insulin errors for people with diabetes in hospital @_ChristinaLange