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Health

Safe hospital insulin use for older adults, with or without frailty, undergoing surgical hospital admission

SHINE is a co-design study with older adults with diabetes and multiprofessional staff working across perioperative care, developing an intervention to improve hospital insulin safety.

Insulin is a high-risk and time-critical drug which is essential in the management of many people with diabetes. Despite many interventions, national audit data has shown that up to 40% of inpatients with diabetes treated with insulin experience at least one insulin error.

Insulin errors can lead to significant patient harm. This includes development of dangerously low or high blood glucose levels. Errors can impact on inpatient experience. They can cause increased anxiety and stress, complications and length of stay.

Having good blood glucose levels before, during and after surgery is important to reduce risks of complications. Insulin often plays a key role in achieving this. Many factors contribute to insulin errors. Older adults may have characteristics which increase their risks for insulin error. There has been a lack of involvement of people with diabetes in the development of theory driven interventions to enhance hospital insulin safety. This novel study will work with staff and older adults with recent experience of hospital admission at one NHS site. Together, they will identify priorities and components to develop in an intervention to improve hospital insulin safety.

Aims

  • To understand the experiences and perspectives of older adults with diabetes and hospital staff managing insulin during a surgical hospital admission.
  • To bring together older adults with diabetes with or without frailty, multiprofessional staff and researchers in a co-design process to identify components to develop the conceptual model of a system-based intervention to improve hospital insulin safety.

Tools developed as part of SHINE Study

Building on the insights of SHINE Study, we have co-designed with people with diabetes and frontline staff, two tools to facilitate empowerment and increased preparedness for people with diabetes. 

Hospital insulin safety starts in the community: ways you can help and why

This tool is aimed at healthcare professionals working in the community and outpatient settings. It raises awareness of the complex problem of insulin errors and how these can impact on people with diabetes.

It highlights some of the system contributing factors to errors and provides guidance on simple actions clinicians can take to mitigate these and build system resilience, through increasing accessibility of information at transitions of care and increasing patient empowerment. 

Hospital insulin safety starts in the community: ways you can help and why. Why this is important: 40% of inpatients with diabetes treated with insulin experience at least one insulin error. Insulin errors can lead to acute diabetes emergencies such as hypoglycaemia, DKA and HHS and impact on patient experience: increased anxiety, stress, complications and hospital length of stay and decreased trust in health care professions. How and why do errors happen? Insulin is a high-risk drug which means potential harm from errors can be severe, including life-threatening outcomes. It is also a time critical drug which means timing is crucial for safe and effective treatment. Common contributing factors in errors include: breakdown in communication, lack of access to information on usual insulin treatment such as name of insulin, doses, timings and devices, and the equipment at the point of care. Patient factors such as clinical or cognitive status, expectations and assumptions, understanding, complex medical history, social factors and communication difficulties. Disjointed process and systems, staffing and busy workload. Staff knowledge and confidence gaps. Self-administration of insulin not always facilitated. These factors are particularly heightened at transitions of care. What to do about it? At clinical reviews: check with your patient how they manage their insulin treatment. Document usual insulin treatment details including insulin name, devices, doses and timings. Where possible, empower people with diabetes to prepare for hospital admission. This may include safety netting advice on: What to take with them to hospital; what to tell hospital staff; the possibility of self-administration of insulin in hospital; how to ensure their diabetes is managed safely in hospital; how to prepare for planned surgery. Please see ‘5 tips for safe hospital stay’ infographic. This is essential for: People with planned admissions or surgery; older adults and/or individuals with frailty; people at higher risk of hospital admission.

Five tips to prepare for a safer hospital stay

This tool is aimed at people with diabetes and is aimed at empowering them with information to support increased preparedness for hospital admission. It is available as an infographic and as an animation

An infographic that reads: If you have diabetes and have to attend or be admitted to hospital, these 5 tips will help you prepare for a safe hospital stay. 1. Tell hospital staff that you have diabetes, Don’t assume they already know as not all healthcare records are fully integrated. Let staff know if you use diabetes tech (glucose sensor or insulin pump) or have had any recent issues such as ‘hypos’ (low glucose levels). 2. Keep an updated list of your usual medications easily accessible. If you take insulin, include its full name, doses and timings. Consider sharing your list with a trusted family member or friend, who can help supply accurate information if you are too unwell to do so. 3. Take your medications and usual diabetes management kit with you into hospital, if possible. Especially your insulin, if you take this. 4. If you want to and are well enough, you should be able to self-manage your insulin in hospital. Discuss this with the staff looking after you, so an agreement form can be signed for you to manage and have access to your insulin. 5. If you are due to have a surgical procedure, ask to be provided with ‘My diabetes passport:planning for surgery”. This contains important information about preparing for surgery for a person with diabetes.A Welsh translation of the above infographic

For those who would like to use these resources in their own practice or for their own purposes, please get in touch at the email address above.

Impact

Research undertaken as part of SHINE Study:

  • Was awarded the Rowan Hillson Inpatient Diabetes Award 2025 with its submission entitled: Empowering people with diabetes to prepare for a safer hospital stay
  • Has been selected as a Finalist for the category Insulin Safety Week Excellence Award at the Quality in Care (QiC) Diabetes 2025 Awards.

Our Partners

Wye Valley NHS Trust logo

Wye Valley NHS Trust

FEND logo

Foundation of European Nurses in Diabetes (FEND)

Project status: Completed

Investigators

Funding

Funding Body: Foundation of European Nurses in Diabetes (FEND)

Amount: £150,000

Period: March 2024 - March 2025

Contact us

Christina.Lange_Ferreira@kcl.ac.uk

Keywords

DIABETES MELLITUSINSULININPATIENT SAFETYOLDER ADULTFRAILTYCO-DESIGNMEDICINES SAFETY