Patient Advocacy Essay

Pages: 6 (2149 words)  ·  Bibliography Sources: 3  ·  File: .docx  ·  Level: College Senior  ·  Topic: Healthcare

Nursing

Patient Advocacy

Even though the use of insulin pens has become more and more common among those patients who are on insulin therapy, the use of these pens has been banned in most hospitals due to safety issues that have arisen surrounding them. These issues need to be dealt with so that these pens can once again be used in hospital settings. Insulin pens provide a host of benefits to the patients that use them along with being beneficial in cost savings to those hospitals that do use them.

The phobias that often surround the use of syringes and needles tend to complicate matters when it comes to insulin delivery. Some people associate needles with illegal drugs, while others fear the social stigma of having to inject themselves in public. Still others are afraid injections will be too painful. Even though those mistaken beliefs and fears can be dismissed, they can lead people to refuse or delay the beginning of their insulin therapy, or result in poor faithfulness once they've started. Such obstacles have prompted researchers to look into different delivery methods, including inhaled, oral or skin-patch insulin (On Pens and Needles, 2010).

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Novo Nordisk, in 1985, launched the first insulin pen. Since that time, Eli Lilly and Sanofi-Aventis have also put insulin pens on the market. All three companies are the primary manufacturers of insulin products. The pens have undergone some changes over time, mechanically, stylistically and ergonomically. Still each one functions pretty much the same. After taking the pen cap off, the first thing that needs to be done is to screw on a new pen needle, which fits into a cartridge of insulin. On the other end of the pen, a numerical dial is turned in order to the precise dosage number needed at that time. The dial can be heard clicking at each number and on most pens can be adjusted to the correct dose if you dial the wrong number (On Pens and Needles, 2010). Insulin pens make it more opportune for diabetics to inject insulin. They most often already hold the patient's prescribed insulin and allow each dose to be adjusted to the patient's requirements. They are easier to carry that insulin syringes and vials (Alert issued about use of insulin pens for hospitalized diabetic patients, 2009).

TOPIC: Essay on Patient Advocacy Assignment

For some patients who have diabetes, the need to complete self-injection can be a barrier to acceptance of insulin therapy. Other perceived barriers to insulin therapy include inconvenience and portability of the insulin delivery device. Insulin pen devices provide a delivery option that may be more acceptable and more convenient to use than traditional vials and syringes. This, in turn, may promote patient adherence, which can enhance the ability to achieve and maintain glycemic control. Studies have shown that patients do in fact prefer insulin pens to vial and syringe and believe that that pen devices are more convenient, provide greater lifestyle flexibility, clinical efficacy, and improve their quality of life. There also may be clinical benefits in using insulin pen delivery devices for patients with type 2 diabetes (Kruger, 2008).

Advances in glycemic control have been shown to greatly reduce the progression of microvascular difficulties in patients with diabetes. Faithfulness to insulin therapy is a major factor in patients achieving glycemic control. Regardless of the accessibility of insulin pens, hospitals have continued to use vials and syringes for subcutaneous injections. One reason that insulin pens have not used in many hospitals is because there was no automatic safety feature that would prevent accidental needle sticks in health care workers (Davis, Christensen, Nystrom, Foral and Destache, 2008).

One possible reason that needle stick injuries are occurring is because the pen often makes it difficult to see the injection site. In addition, some needles do not have needle guards, so a needle stick can take place after the injection. Another problem is that it is possible that not all of the insulin in the pen gets distributed. This occurs because some of the buttons on some pens are hard to push down, making it easy to accidentally lift the needle out of the skin during the injection. There is also the possibility for seepage around the injection site if the needle is not left in place for at least six seconds following the injection. In addition, unbalanced dosing of an insulin suspension can occur if the user fails to tip and roll the pen before the insertion, causing the suspension to clump. Sometimes nurses who are not familiar with a particular type of pen will use it as a multiple-dose vial, withdrawing insulin from the pen cartridge with a sterile needle and a normal insulin syringe. This is not suggested, due to the fact that removing insulin from the cartridge can leave air pockets in it. When the cartridge is used for a second time, these air pockets can cause dosing errors or air injections. Another difficulty occurs when the same pen is used for multiple patients, as this is potentially dangerous. Connecting a new sterile needle to the pen before using it on another patient does not necessarily solve this problem. This is due to the fact that the insulin inside the pen's cartridge can become tainted with biological substance after the first injection, while the original needle is still on the pen. Lastly, the design of some pens can lead to dosing errors (Potential Problems with Insulin Pens in Hospitals, 2008).

When vials are utilized in a hospital they are often used to prepare more than one patient's insulin dose, using a new needle and syringe for each does. This is an established practice that is safe as long as a new syringe and needle is used for each patient. Conversely, when insulin pens are used in a hospital they are intended to be used one patient only. But according to some research, sometimes even though staff changed the pen's needle between patients, they reused the pen for more than one patient (Alert issued about use of insulin pens for hospitalized diabetic patients, 2009). The Institute for Safe Medication Practices, which operates ConsumerMedSafety.org, has formerly warned hospitals about reuse of insulin pens on more than one patient because at least two studies have shown that contamination of insulin occurred in up to half of all reused insulin pen cartridges. Air bubbles and microorganisms can get in the insulin compartment of the pen after injection, while the needle is still joined to the pen. Insulin pens were intended for use by patients in the home and not by nurses in the hospital. They are not suitable for multiple patients without risking cross-contamination (Alert issued about use of insulin pens for hospitalized diabetic patients, 2009).

Due to the fact that the problems seem to stem around nurse administration of insulin using these pens, it makes sense to look at that areas as a starting point for possible solutions. Generally speaking, there are two fundamental types of nursing leadership styles, democratic and autocratic. A nurse leader who leads with a democratic style often uses their nurses in decision-making and let them carry out their work in an autonomous manner. While, an autocratic leader would provide instructions without asking for inputs and supervise their nurses in a very close style. A nurse leader who has a substantial amount of work practice would select a leadership and management style that would work best in any circumstance. Nurse leaders significantly need to be very stress and tension-free while supervising things, as they work in a critical life and death situation where every moment counts and where temperamental or emotional behavior is not accepted. They have to be able to fully focus on their job functions, as it may be a question of life or death (Leadership Styles in Nursing, 2010).

It is thought that it is not safe for a hospital to switch from insulin vials to insulin pens without putting their nurses through a thorough educational program. It is not enough to simply point out how these devices work and how they are used, it is very important to recognize how humans, even experienced health professionals, can use them improperly and the harm that can result. There are thought to be certain safety advantages in using the insulin pens. The pens are thought to reduce the chance of drug mix-ups, since each pen is pre-labeled with product name and strength, and the patient's name can be on the label as well (Potential Problems with Insulin Pens in Hospitals, 2008).

Implementing a rigorous educational program would be one viable solution to this problem. Leadership needs to develop an educational program with input from the floor nurses as to why these safety issues are occurring. Once the program has been developed then all nurses should be required to go through it. This will help to ensure that things are being done correctly and that patient safety is the foremost concern of all involved.

Another solution would be to make sure that all… [END OF PREVIEW] . . . READ MORE

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