ISMP cites serious breaches in ambulatory pump safety

There are “significant breaches” in safe practices associated with managing hospital patients with external ambulatory pumps, according to a new survey from the Institute for Safe Medication Practices (ISMP).

“This is a serious risk given that the use of ambulatory pumps is no longer a rare occurrence-more than half a million people with diabetes are using ambulatory insulin pumps, alone,” ISMP wrote in its November 19 Acute Care ISMP Medication Safety Alert! newsletter. “We also found that a large number of respondents did not even know whether certain policies, procedures, guidelines, or practices were in place in their hospitals to safeguard patients with an ambulatory pump.”

After surveying hospital pharmacists, nurses, and diabetes educators, ISMP found that 75% of survey respondents do not have a policy, procedure, or guideline in place regarding the management of patients who present for care with insulin being delivered via an external pump.

Sixteen percent of respondents’ hospitals have a policy to halt use of the insulin pump during hospitalization, which may place patients at risk for ketoacidosis unless the hospital has a robust system for replacing the needed insulin. “But only half of respondents’ hospitals provide guidance regarding how to manage the patient with subcutaneous or IV insulin if the pump must be halted. Also, if an insulin pump must be temporarily discontinued, just 40% of respondents specify how to do this, where to store the pump, and when to reconnect it,” ISMP wrote.

About half of the survey respondents said that any insulin used to refill the pump must be dispensed or verified by pharmacy, and that guidelines exist regarding who can prepare the insulin, fill the device, and program it. “However, only 17% of respondents reported that refills are carried out by clinicians with demonstrated competencies and 25% said that an independent double check is required for refills before restarting the pump.

Using the survey data and other resources, ISMP plans to develop guidelines to help hospitals establish a safe environment for patients with ambulatory pumps.