Insulin-Related Medication Errors and Contributing Factors at Kenyatta National Hospital
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Introduction:  Insulin is used in the management of hyperglycemia attributed to diabetes, a chronic illness with a prevalence of 4.7% in Kenyan adults. Insulin has a narrow therapeutic index and is ranked among the top 5 “high alert” medications by the Institute of Safe Medication Practices. High alert medications bear a significant risk of patient harm including death when used inappropriately. Medication prescription errors affect the quality of care by contributing to poor patient outcomes hence patient safety is a prime target for healthcare improvement.  

Objective:  This study aimed to determine the magnitude of insulin prescription errors and contributing factors in adult diabetic patients in Kenyatta National Hospital.

Methodology: The study was carried out in Kenyatta National Hospital, a public teaching and referral hospital in Nairobi, Kenya. A cross-sectional study design was used. The study consisted of two parts. The first part involved identification of insulin prescription errors in the adult medical wards and diabetic clinic through inspection of medication orders and review of 266 diabetic patients’ records. A checklist was also administered to healthcare workers in these wards, clinic and pharmacies that serve them to assess the patient safety practices and identify factors that could contribute to the prescription errors. Descriptive statistics were used to present data using mean, median, range, frequency and percentages. The second part was qualitative where in-depth interviews were conducted with key informants to further explore gaps in the patient safety practice and identify recommendations to mitigate occurrence of insulin prescription errors. Thematic analysis of the qualitative data was carried out.

Results: The prevalence of insulin use among 142 discharged diabetics from the general medical wards was found to be about 60%. Out of 266 records reviewed over the study period the prevalence of insulin prescription errors was found to be 98.5%. Insulin prescription errors were identified in all 181 outpatient records and in 95.3% of the 85 inpatient records reviewed. A total of 409 insulin prescription errors were identified. An overall prescription error rate of 19.2% was determined. The use of dangerous abbreviations (62.4%) and failure to request monitoring parameter (31.8%) were the most commonly encountered errors. The patient safety system was assessed in 12 units during the study. It was found that only 2 out of 13 structural components for minimizing insulin prescription errors were present in at least 50% of the units visited. There were 8 out of 18 process components for minimizing insulin prescription errors present in at least 50% of the units visited.  Factors that contributed to insulin prescription errors included lack of standard guidelines, knowledge gap among healthcare workers, inadequate supervision, staffing constraints and limited pharmacist participation in clinical areas.

Conclusion: The prevalence of insulin prescription errors was high. The hospital was found to have a weak patient safety system which could not adequately check against insulin prescription errors hence the high magnitude of these errors.