Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

Author:

Najmi Urooj1,Haque Waqas Zia23ORCID,Ansari Umair4ORCID,Yemane Eyerusalem4,Alexander Lee Ann4,Lee Christina4,Demidowich Andrew P.56ORCID,Motevalli Mahsa7,Mackay Periwinkle8,Tucker Cynthia8,Notobartolo Cindy9,Sartippour Poroshat10,Raynor Jennifer4,Zilbermint Mihail6711ORCID

Affiliation:

1. American International School of Medicine, Atlanta, GA, USA

2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

3. University of Texas Southwestern Medical School, Dallas, TX, USA

4. Pharmacy Department, Suburban Hospital, Bethesda, MD, USA

5. Johns Hopkins Community Physicians at Howard County General Hospital, Columbia, MD, USA

6. Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA

7. Johns Hopkins Community Physicians at Suburban Hospital, Bethesda, MD, USA

8. Department of Nursing Education, Suburban Hospital, Bethesda, MD, USA

9. Department of Safety, Security and Employee Health Services, Suburban Hospital, Bethesda, MD, USA

10. Department of Management Information System, Suburban Hospital, Bethesda, MD, USA

11. Johns Hopkins Carey Business School, Baltimore, MD, USA

Abstract

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

Publisher

SAGE Publications

Subject

Biomedical Engineering,Bioengineering,Endocrinology, Diabetes and Metabolism,Internal Medicine

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