Errors in the administration of insulin by clinical staff are common. In certain cases they may be severe and can cause death. Two common errors have been identified:

• the inappropriate use of non-insulin (IV) syringes, which are marked in ml and not in insulin units; 
• the use of abbreviations such as ‘U’ or ‘IU’ for units. When abbreviations are added to the intended dose, the dose may be misread, e.g. 10U is read as 100.

Some of these errors have resulted from insufficient training in the use of insulin by healthcare professionals.

All organisations in the NHS and independent sector should ensure that:

1.   All regular and single insulin (bolus) doses are measured and administered using an insulin syringe or commercial insulin pen device. Intravenous syringes must never be used for insulin administration.

2.   The term ‘units’ is used in all contexts. Abbreviations, such as ‘U’ or ‘IU’, are never used.

3.   All clinical areas and community staff treating patients with insulin have adequate supplies of insulin syringes and subcutaneous needles, which staff can obtain at all times.

4.   An insulin syringe must always be used to measure and prepare insulin for an intravenous infusion. Insulin infusions are administered in 50ml intravenous syringes or larger infusion bags. Consideration should be given to the supply and use of ready to administer infusion products e.g. prefilled syringes of fast acting insulin 50 units in 50ml sodium chloride 0.9%.

5.   A training programme should be put in place for all healthcare staff (including medical staff) expected to prescribe, prepare and administer insulin. An e-learning programme is available from NHS Diabetes at: www.diabetes.nhs.uk/safe_use_of_insulin

6.   Policies and procedures for the preparation and administration of insulin and insulin infusions in clinical areas are reviewed to ensure compliance with the above.

The Rapid Response Report and Supporting Information is also on the NPSA website at www.nrls.npsa.nhs.uk/resources/type/alerts