Quantitative Evaluation of Compounded Errors During Insulin Administration – A Multicentric Brazilian Study

Abstract

Studies evaluating errors in self-administration of insulin usually address the qualitative aspects. We quantitatively evaluated the various errors committed by patients during self-administration. After due approval by Ethics Committees the study included 140 individuals aged 6-75 years, insulinized for more than 6 months. Participants in this study responded to a structured questionnaire exploring their insulin self-administration practices under the supervision of a trained nurse. This questionnaire addressed the most commonly found errors in application technique. Data were analyzed by McNemar test used to compare proportions in paired groups using the software SPSS 16.0 for Windows. The main problem identified by the study was the high percentage of errors in withdrawing the prescribed dose of insulin from the vial: 50% of incorrect doses in the adult group and 60% in the young group with syringes of 100 IU. Significant reduction in this error was detected with the use of 30U and 50U syringes, when the percentage error ranged from 31% to 34% of incorrect doses in adult group and 0% to 5% in the young group. Other major errors included: adequate rotation technique by just 28.3%; premature withdrawal of the needle from subcutaneous tissue by 46.7%, causing reflux of injected insulin. An overall assessment found that self-administration of insulin was considered as entirely proper by just 10% of the subjects. Quantitative evaluation of the study data showed a very critical situation in relation to the poor techniques of insulin administration, with the occurrence of substantial major errors that may compromise the success of diabetes treatment. The overall results of the study point to a need for immediate implementation of effective educational strategies that could provide the patient with the basic knowledge needed to minimize the potential risks of self-administration of insulin.