Implementing self-administration of insulin in hospital: a journey of discovery and innovation. Part 1: Culture and storage

Vicki L Rowse



Patients with diabetes routinely manage their insulin at home, but when they are admitted to hospital it is common practice to take their insulin away and store it in the ward fridge. Medicines rounds and mealtimes are poorly aligned and, as a result, patients can have delayed doses and increased hypo- and hyperglycaemic episodes. Best practice states that patients should be offered self-administration of insulin, but it is not routine in most trusts. This paper reports on a project to increase the number of patients assessed and supported to administer their insulin in hospital, the reasons why the project was initially unsuccessful and the challenges of changing culture and beliefs around insulin administration. A second paper discusses steps taken to support changes in hospital trusts.


insulin, inpatients, safety, culture

Full Text:



Diabetes UK. Reducing diabetes harms in hospital: National Diabetes Mortality and Morbidity Project. Key themes from a learning event with Diabetes Mortality and Mortality project participants, 13 February 2015.

Diabetes UK. The State of the Nation. 2016.

Sampson MJ, Crowle T, Dhatariya K, et al. Trends in bed occupancy for inpatients with diabetes before and after the introduction of a diabetes inpatient specialist nurse service. Diabet Med 2006;23:1008-115.

Yorkshire and Humber Public Health Observatory Diabetes Health Intelligence. Mortality among inpatients with diabetes: key findings for England. May 2012. (accessed 16 June 2017).

National Institute for Health and Care Excellence. Diabetes in adults. Quality Standard [QS6]. 2011 (updated 2016). (accessed 16 June 2107).

NHS Diabetes. Joint British Diabetes Societies for Inpatient Care Group. Self-management of diabetes in hospital. March 2012. (accessed 16 June 2017)

NHS Improvement. Patient Safety Alert. Risk of severe harm and death due to withdrawing insulin from pen devices. 16 November 2016. NHS/PSA/W/2016/011. (accessed 16 June 2017).

Wessex Academic Health Science Network. Self-administration of insulin in hospital: a guide to support Trusts through the implementation process. 2017. (accessed 16 June 2017).

Royal Pharmaceutical Society. The safe and secure handling of medicines: a team approach. A revision of the Duthie Report (1988) led by the Hospital Pharmacists’ Group of the Royal Pharmaceutical Society. March 2005. (accessed 16 June 2017).

Nursing and Midwifery Council. Standards for Medicines Management. 2007 (updated 2010). (accessed 16 June 2017).

Billington S. Head of Medicines Optimisation, Primary Medical Services and Integrated Care Directorate, Care Quality Commission. By email 16 August 2017 and 16 July 2015.



  • There are currently no refbacks.

The Journal of the Association of British Clinical Diabetologists