Safety

• Follow the Six Rights of Medication Administration: right medication, right dose, right patient, right route, right time, and right documentation.
• Know the onset, peak, and duration of all insulin given. Timing of insulin injection is critical to correct insulin administration.
• Bring insulin to room temperature if it has been refrigerated prior to administration.
• Visually inspect the insulin vial before administration. Do not use insulin if you note clumping, frosting, precipitation, altered clarity, or altered color.
• Do not mix insulin with any other medication or diluent unless approved by the health care provider.
• Since insulin is considered a “high-alert” medication, have another registered nurse double-check the type and amount after it has been draw up into the syringe and before administration.
• Do not mix insulin glargine (Lantus®) or insulin detemir (Levemir®) with any other types of insulin, and do not administer either intravenously.
• Mixed insulins containing a rapid- or short-acting insulin should injected no earlier than 5 to 15 minutes before a meal.
• When mixing medications from two vials, do not contaminate one medication with another.
• Always draw up the short- or rapid-acting insulin before the longer-acting insulin to prevent its being contaminated with the longer-acting insulin.
• The sequence in which vials are prepared or drawn does not matter when mixing two intermediate-acting insulins in the same syringe.
• Maintain aseptic technique during preparation of insulin for injection.

Equipment

(Roll cursor over items to see labels)

Rapid- or short-acting insulin (multidose vial)

Longer-acting insulin (multidose vial)

U-100 insulin syringe with 29-guage, 1/2 needle

Alcohol swabs

Tape (to label syringe if needed)

Delegation

The skill of preparing insulin and mixing more than one type in one syringe may not be delegated to nursing assistive personnel (NAP).

Preparation

• Check the accuracy and completeness of each medication administration record (MAR) against the health care provider’s medication orders. Confirm the patient’s name, the specific type of insulin, the dosage in units, and the time of administration. Clarify incomplete or unclear orders with the health care provider.
• Note if the patient has allergies.
• Determine the region where previous insulin injections have been given, and plan to use a different site within the same region.
• Obtain the patient's current blood glucose level prior to preparing insulin.
• Familiarize yourself with the expected action, onset, peak, and duration of the prescribed insulin(s).
• Coordinate the administration of rapid- and short-acting insulin with mealtime, Rapid-acting insulin is administered no more than 5 to 15 minutes before a meal. Short-acting insulin is administered no more than 20 to 30 minutes before a meal.
• Draw up the appropriate dose of insulin into the insulin syringe. Check the label of the insulin and the amount drawn into the syringe against the MAR two times. Check the expiration date on the vial.
• Roll an insulin suspension preparation between your palms before drawing it up into the syringe.

Follow-up

• Take the insulin to the patient’s bedside for administration.
• Before administrating the insulin to the patient, compare the MAR with the label on the prepared insulin syringe.

Documentation

Record insulin administration after giving the drug. It is not necessary to document separately the preparation or mixing of insulin.

Record blood glucose levels as ordered prior to the administration of insulin.