Resource Center
Resources from Organizations
American Society of Health-System Pharmacists
- Strategies for Ensuring the Safe Use of Insulin Pens in the Hospital
- One Pen, One Patient initiative with educational activities, virtual mentoring (program completed), tool kit, and resource center
- AJHP supplement on best practices in ensuring safe use of insulin pens in the hospital, including recommendations from a Delphi consensus development process
Centers for Disease Control and Prevention Safe Injection Practices Coalition
- One & Only campaign
- Insulin pen posters and brochures for health care professionals and patients
Institute for Safe Medication Practices
- Insulin pen safety webpage
- Insulin safety during a hospitalization webpage
- ISMP Medication Safety Alert! newsletters (acute care edition)
- ISMP National Medication Errors Reporting Program
Society of Hospital Medicine
- Glycemic Control Implementation Guide
- Best practices on glycemic control in the inpatient setting, including safe use of insulin pens and transitions of care
U.S. Food and Drug Administration
- Safety communication: Label warnings required to prohibit pen device sharing
- Drugs@FDA: Approved Drug Products Database
Articles and Guidelines
UPDATED Incorporating Newer Concentrated Insulin Pens into Practice
- Andres J, Clements JN. A practical guide to concentrated insulin for pharmacists.
J Pharm Pract. 2014; 27:481-6. - Barnosky A, Shah L, Meah F et al. A primer on concentrated insulins: what an internist should know. Postgrad Med. 2016; 128:381-90.
- Institute for Safe Medication Practices. U-500 insulin pen arriving soon. ISMP Medication Safety Alert! Acute Care Edition.2016; 21(1)1-6.
- Institute for Safe Medication Practices. Pen device for U-500 insulin makes great sense. ISMP Medication Safety Alert! Acute Care Edition. 2016(Jan 28); 21(2)1-4.
- Institute for Safe Medication Practices. Hardwiring safety into the computer system: one hospital’s actions to provide technology support for U-500 insulin. ISMP Medication Safety Alert! Acute Care Edition. 2016(May 5); 21(9)1-5.
- Institute for Safe Medication Practices. Misuse of new insulin strengths. ISMP Medication Safety Alert! Acute Care Edition. 2016(Jun 16); 21(12):1-6.
- Lamos EM, Younk LM, Davis SN. Concentrated insulins: the new basal insulins. Ther Clin Risk Manag. 2016; 12:389-400.
- Mospan CM. What is the role of concentrated insulin in diabetes management? JAAPA. 2016; 29(6):16-8.
- Painter NA, Sisson E. An overview of concentrated insulin products. Diabetes Spectr. 2016; 29:136-40.
- Samaan KH, Dahlke M, Stover J. Addressing safety concerns about U-500 insulin in a hospital setting. Am J Health-Syst Pharm. 2011; 68:63-8.
- Segal AR, Brunner JE, Burch FT, Jackson JA. Use of concentrated insulin human regular (U-500) for patients with diabetes. Am J Health-Syst Pharm. 2010; 67:1526-35.
- Segal AR, Vootla T, Beaser RS. Insulin: making sense of current options. Endocrinol Metab Clin North Am. 2016; 45:845-74.
Articles and guidelines on inpatient hyperglycemia
- Bogun M, Inzucchi SE. Inpatient management of diabetes and hyperglycemia. Clin Ther. 2013; 35:724-33.
- Moghissi ES, Korytkowski MT, DiNardo M et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009; 32:1119-31.
- Umpierrez GE, Hellman R, Korytkowski MT et al. Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012; 97:16-38.
- Umpierrez GE, Isaacs SD, Bazargan N et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol. Metab. 2002; 87:978-82.
Guidelines and consensus statements on insulin therapy and safe use of insulin pens
- American Diabetes Association. Standards of medical care in diabetes—2016. Diabetes Care. 2016; 39 (Suppl 1): S1-S112.
- Cobaugh DJ, Maynard G, Cooper L et al. Enhancing insulin-use safety in hospitals: Practical recommendations from an ASHP Foundation expert consensus panel. Am J Health-Syst Pharm. 2013; 70:1404-13.
- Haines ST, Miklich MA, Rochester-Eyeguokan C. Best practices for safe use of insulin pen devices in hospitals: recommendations from an expert panel Delphi consensus process. Am J Health-Syst Pharm. 2016; 73(suppl 5): S4-S16.
Articles on insulin pens
- Botsford JA. Building on a safety culture with transparency by participating in a mentored quality-improvement program for insulin pen safety. Am J Health-Syst Pharm. 2016; 73(suppl 5): S38-S44.
- Cohen MR. Pharmacists' role in ensuring safe and effective hospital use of insulin. Am J Health-Syst Pharm. 2010; 67(16 Suppl 8):S17-21.
- Davis EM, Christensen CM, Nystrom KK et al. Patient satisfaction and costs associated with insulin administered by pen device or syringe during hospitalization. Am J Health-Syst Pharm. 2008; 65:1347-57.
- Davis EM, Bebee A, Crawford L, Destache C. Nurse satisfaction using insulin pens in hospitalized patients. Diabetes Educ. 2009; 35:799-809.
- Davis EM, Foral PA, Dull RB, Smith AN. Review of insulin therapy and pen use in hospitalized patients. Hosp Pharm. 2013; 48:396-405.
- Edmondson G, Criswell J, Krueger L, Eby EL. Economic impact of converting from 10-mL insulin vials to 3-mL vials and pens in a hospital setting. Am J Health-Syst Pharm. 2014; 71:1485-9.
- Greenwood B, Szumita PM, Pendergrass M. Conversion to insulin devices in the inpatient setting. Am J Health-Syst Pharm. 2008; 65:698-9.
- Grissinger M. Avoiding problems with insulin pens in the hospital. P & T. 2011; 36:615-6.
- Hertig JB, Brown K. Utilization of insulin pens in long-term care. Ann Long-Term Care: Clin Care Aging. 2016; 24(1):17-24.
- Institute for Safe Medication Practices. Cross contamination with insulin pens. ISMP Medication Safety Alert! Acute Care Edition. March 27, 2008.
- Institute for Safe Medication Practices. Reuse of insulin pen for multiple patients risks transmission of bloodborne disease. ISMP Medication Safety Alert! Acute Care Edition. February 12, 2009.
- Institute for Safe Medication Practices. Is ISMP endorsing use of insulin pens in hospitals? ISMP Medication Safety Alert! Acute Care Edition. 2010(Oct 21); 15(21):2.
- Institute for Safe Medication Practices. Do not use an insulin pen for multiple patients! ISMP Medication Safety Alert! Acute Care Edition. 2012(Jan 12); 17(1):1,4.
- Institute for Safe Medication Practices. CMS citing reuse of insulin pens. ISMP Medication Safety Alert! Acute Care Edition. 2012(May 31); 17(11):2.
- Institute for Safe Medication Practices. Ongoing concern about insulin pen reuse shows hospitals need to consider transitioning away from them. ISMP Medication Safety Alert! Acute Care Edition. February 7, 2013.
- Institute for Safe Medication Practices. A clinical reminder about the safe use of insulin vials. ISMP Medication Safety Alert! Acute Care Edition. February 21, 2013.
- Institute for Safe Medication Practices. A crack in our best armor: “wrong patient” insulin pen injections alarmingly frequent even with barcode scanning. ISMP Medication Safety Alert! Acute Care Edition. October 23, 2014.
- Institute for Safe Medication Practices. U-500 syringe approved by FDA. ISMP Medication Safety Alert! Acute Care Edition. 2016(Jul 14); 21(14):1-2.
- Lutz MF, Haines ST, Lesch CA, Szumita PM. Facilitating the safe use of insulin pens in hospitals through a mentored quality-improvement program. Am J Health-Syst Pharm. 2016; 73(suppl 5): S17-S31.
- Meece J. Effect of insulin pen devices on the management of diabetes mellitus. Am J Health-Syst Pharm. 2008; 65:1076-82.
- Rosenberg AF. Participation in a mentored quality-improvement program for insulin pen safety: opportunity to augment internal evaluation and share with peers. Am J Health-Syst Pharm. 2016; 73(suppl 5): S32-S37.
- Sheldon KA, Seoane-Vazquez E, Szeinbach SL, Tubbs C. Using the plan-do-study-act model to convert to a new insulin delivery system. Am J Health-Syst Pharm. 2009; 66:1074-5.
Reports and alerts on insulin pen sharing or contamination
- Centers for Disease Control and Prevention. CDC clinical reminder: insulin pens must never be used for more than one person. January 5, 2012.
- Centers for Medicare & Medicaid Services Director, Survey and Certification Group. Memorandum to state survey agency directors: use of insulin pens in health care facilities. May 18, 2012.
- Centers for Medicare and Medicaid Services Director, Survey and Certification Group. Memorandum to state survey agency directors: infection control breaches which warrant referral to public health authorities. May 30, 2014.
- Hakre S, Upshaw-Combs DR, Sanders-Buell EE et al. An investigation of bloodborne pathogen transmission due to multipatient sharing of insulin pens. Mil Med. 2012; 177:930-8.
- Herdman ML, Larck C, Schliesser SH, Jelic TM. Biological contamination of insulin pens in a hospital setting. Am J Health-Syst Pharm. 2013; 70:1244-8.
- Institute for Safe Medication Practices. 4,200 need testing after pen misuse. ISMP Medication Safety Alert! Acute Care Edition. April 13, 2014.
- Le Floch JP, Herbreteau C, Lange G, Perlemuter L. Biologic material in needles and cartridges after insulin injection with a pen in diabetic patients. Diabetes Care. 1998; 21:1502-4.
- Sonoki K, Yoshinari M, Iwase M et al. Regurgitation of blood into insulin cartridges in the pen-like injectors. Diabetes Care. 2001; 24:603-4.
- U.S. Food and Drug Administration. Information for healthcare professionals: risk of transmission of blood-borne pathogens from shared use of insulin pens. March 19, 2009.
- U.S. Food and Drug Administration. FDA drug safety communication: FDA requires label warnings to prohibit sharing of multi-dose diabetes pen devices among patients. February 25, 2015.