ISMP cautions on insulin pen needle risk for patients

Differences in standard and automatic insulin pen needles exist; education varies

The Institute for Safe Medication Practices (ISMP) is alerting pharmacists and other practitioners about the safety risks associated with improper use of insulin pen needles. The warning comes after ISMP received several reports about patients and caregivers failing to remove the inner cover of standard insulin pen needles before administering insulin. The safety warning was published in ISMP’s National Alert Network.

ISMP said that patients may not be aware of the operating differences between standard insulin pen needles and pen needles with automatic needle shields, which are often used in hospitals or long-term care facilities to prevent needle-stick injuries. These needles look similar, but standard pen needles require an extra step that is not needed with automatic needle-shield pens (see diagram). Pens with built-in needle safety include products such as NovoFine Autocover (Novo Nordisk) and BD AutoShield Duo (BD). They automatically re-cover and lock the pen needle once injection has been completed and the needle has been withdrawn from the skin.

One hospital, which reported an adverse event to ISMP about improper use, changed to using standard nonsafety needles when training patients prior to discharge to ensure they know how to administer insulin with the same pen and needle they use at home.

For many diabetes specialists, these reports highlight the need for higher standards when educating patients with diabetes on insulin pen use.

“I think there’s huge variability on how patients are educated,” said Abby Winter, PharmD, BCACP, from the Endocrine and Diabetes Care Center at the University of Washington Medical Center–Roosevelt in Seattle.

In the alert, ISMP asked community pharmacists to verify that the patient understands the appropriate administration technique whenever pens and insulin needles are dispensed. “A request to conduct this verification at the point of dispensing could be entered in the notes section of an electronic prescription or included on handwritten prescriptions,” noted ISMP. The organization also urges practitioners to have patients question the pharmacist if the pen needle is different from what they expect or what they have been taught to use.

Winter advises pharmacists to not assume patients know how to administer insulin with their pens, even if they’ve been doing it for a long time.

“Always have the patient show you; don’t take their word for it,” said Winter.

A demonstration is often the biggest learning tool, she said.

“There have been many times when patients will come in for diabetes management and we keep increasing insulin doses, but when you ask patients to show you how they use their insulin pens, you find an error,” said Winter.

For the full article, please visit for the upcoming January 2018 issue of Pharmacy Today.