Newer insulin products consist of biosimilars and faster-acting, longer-acting, or higher-concentration analogues that may come in various packaging and volumes. The latest Safety Bulletin from the Institute for Safe Medication Practices (ISMP) Canada describes a multi-incident analysis of reports involving newer insulin products. The qualitative analysis of incidents identified three themes and associated subthemes:
- vulnerabilities with insulin product changes including
- biosimilar clinical similarities (a designation assigned by Health Canada indicating that a biosimilar is highly similar to its reference biologic drug) versus interchangeability (a designation within the Interactive Drug Benefit List [iDBL] indicating that a drug product has been designated as interchangeable by the Minister of Health), and
- need for medication reconciliation;
- unfamiliar insulin product characteristics including
- availability of multiple and high insulin concentrations, and
- variations in insulin pack sizes and delivery devices; and
- refrigerator storage limitations.
The Safety Bulletin also shares recommendations for prescribers and pharmacy teams for each theme identified to proactively enhance the safe use of these products. Included among the recommendations are the following:
- Vulnerabilities with insulin product changes:
- Create a new entry for each new insulin prescription. Limit use of the copy function to prescriptions that are unchanged from the previous prescription in the patient’s profile.
- Update the patient’s profile with each new prescription for insulin and ensure that discontinued insulins, including previous dosing regimens, are inactivated.
- Unfamiliar insulin product characteristics:
- Communicate insulin dosing in units (not mL) to reduce the risk of dosing errors and misinterpretation across products and concentrations.
- “Show and tell” during patient counselling to demonstrate how to use the insulin product and delivery device to achieve the prescribed dose (in units) and use the teach-back method to ensure the patient’s/caregiver’s understanding. This process can allow for an additional check that the correct insulin product is being dispensed.
- Refrigerator storage limitations:
- Reassess and reconfigure refrigerator organization seasonally (e.g., after publicly funded vaccine campaigns) to ensure adequate, clearly separated storage space for insulin and other cold-chain medications.
ISMP Canada safety bulletins can be a valuable resource for CQI+ activities. During quarterly continuous quality improvement meetings or brief safety huddles, pharmacy teams may find it helpful to review relevant bulletins, discuss how identified risks could apply to their own practice setting, and consider system‑level strategies to support the safe prescribing, assessing, verifying, and administration of high‑alert medications such as insulin.
