Insulin charting and a QUM adventure
Theodora (Teddie) Ziesemer
BPharm, CertDE | Pharmacist, Darling Downs Health (Warwick) | theodora.ziesemer@health.qld.gov.au
[Pharmacy GRIT article no: 20251413]
Participating in the AdPha Resident Training Program has afforded me the possibility to participate in and lead ongoing educational opportunities, including the chance to conduct a Quality Use of Medicines (QUM) research project. Diabetes is the fastest growing chronic condition in Australia according to Diabetes Australia and several patients are admitted to hospital prescribed insulin either as a regular medication or a new medication.1 The diversity of brands and forms of insulin has caused confusion and errors in nursing administration due to the active ingredient being prescribed instead of the brand name. The aim of this project was to review local prescribing and administration practices of insulin for inpatients.
Conducting a QUM research project was not something I thought I would have been able to do several years after finishing university, but I was fortunate to have support from my clinical educator and assistance from a student with an interest in the study area which helped build my confidence. The first steps of preparing the QUM project were a steep learning curve, navigating the requirements of ethics approval and project design. The process for applying for ethics was more complicated than I had anticipated, however with guidance from my clinical educator I was able to navigate the process and obtain ethics approval without any delay in starting the project.
Completing the project required a significant amount of time for data collection which I found difficult to manage. However, with the assistance of a student a broad number of participants from several wards were able to be included. In hindsight, requesting offline time to collect data would have allowed for data to be collected from a larger cohort.
Noting several errors of both prescribing and administration — for example charting of insulin Glargine leading to administration of Toujeo rather than Optisulin — prior to commencing my project, I expected results to be more remarkable and found it interesting that the primary investigatory point was better than expected. Initially, I felt disappointed that the research didn’t highlight glaring gaps in insulin charting and administration, and we weren’t able to prove poor practice; upon reflection however the lack of glaring gaps is a positive as patient harm is minimised. It’s likely that recent local education and awareness activities had improved staff awareness of medication safety but even with these results, it highlights the important role of pharmacists in reviewing the prescribing and administration of insulin. Indeed, this experience hasn’t discouraged me from pursuing further QUM projects as I found the process highlighted unexpected endpoints and further areas for fruitful investigation.
This QUM project and experience has better prepared me to partake and initiate future research projects. Learning all the processes and pathways required to conduct QUM projects and ensuring the recruitment of a team to assist in the completing of the project. I plan to lead future projects which will lead to greater practice change.
References
1. Diabetes Australia. The state of the nation 2024: the diabetes epidemic in Australia. Canberra: Diabetes Australia; 2024. Available from https://www.diabetesaustralia.com.au/wp-content/uploads/State-of-the-Nation-2024-Diabetes-Australia.pdf.