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The Insulin Passport is simply to allow Pharmacists to CYA

tim2000s

tim2000s

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Location
London
Type of diabetes
Type 1
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I just popped in to Boots to pick up a prescription and was told by the dispenser that next time I went back I needed to remember my Insulin Passport. I asked what one was. i was told that it is a record of the insulins that I use. Doing some digging on the web, it appears to be another piece of paper that, to quote the woman from Boots "all pharmacies will soon require you to carry".

When asked why, I was told that it was to stop the provision of incorrect insulins to people because there had been audit points due to fatalities caused by incorrect provision of insulin to patients. Now call me cynical, but this really gets on my ****. *I* have to carry an extra piece of useless paper that *I* have to fill in so that some idiot in a Pharmacy who can't read a Prescription can claim that all necessary checks have been undertaken? Talk about "Cover your backside" And why pray, shouldn't I sue your **** for being stupid? In a court, ignorance is no exception. In addition of course, all prescription releases are double checked, and signed by a second person, so I'm providing a third line of defence for two stupid people who, despite years of training and a degree, are incapable of reading a prescription and acting on it correctly.

Not to mention that, I have to complete the thing in the first place, which opens up so many options for errors that I can't quite believe that this is taking place. As far as I can see this all stinks of Nanny State and cover up in NHS Pharmacy system errors, and I can't understand why more hasn't been made of the underlying issues of incompetency rather than "Leave it to the patient to cover themselves", which has been dressed up as "Patient Empowerment".

Apologies, Rant over, but really, this is just so dumb.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

The passport which is just a small card same size as a credit card has the details of the insulin and your details. It is useful to have to be able to show say a ambulance etc if needed etc its not just for pharmacies to be able to see the correct insulin is given out. I've seen wrong insulin precribed in the past by GPs and the pharmacist question it but if its a Locam then they will not know what is your normal medication.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

Assuming that ambulance staff,gps,pharmacists,locums et al can actually read !
Does anybody refer to the patient notes any more ?
 
Re: The Insulin Passport is simply to allow Pharmacists to C

abs said:
The passport which is just a small card same size as a credit card has the details of the insulin and your details. It is useful to have to be able to show say a ambulance etc if needed etc its not just for pharmacies to be able to see the correct insulin is given out. I've seen wrong insulin precribed in the past by GPs and the pharmacist question it but if its a Locam then they will not know what is your normal medication.
Click to expand...

This is what I find incredibly hard to believe. Even a locum doctor has access to the surgery's records, so can see what your previous prescription was, and they are supposed to be bright enough to use systems such as this. I've been a medic alert member for as long as I can remember, which provides the same set-up as the Passport, but without needing to carry the silly card as there's a phone number on the jewellery which can be phoned.

This strikes me as avoiding doing the hard job of joining up patient records and handing it off to the patient. I carry plenty of forms of ID in my wallet/on my person, so another one which is subtly different really doesn't help.

It all feels as though I am having to deal with a system that likes to pretend that it is an advanced health service but which employs morons.

Whilst I realise that my language may cause offence to some, I am fed up to the back teeth of being the single point of information sharing between the various NHS services, even within the same hospital. None of this stuff is really that hard.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

So is it for the pharmacist to check the dr has got it right on the prescription or to check what they r doing? Bit worrying they r both getting it wrong somewhere


Sent from the Diabetes Forum App
 
Re: The Insulin Passport is simply to allow Pharmacists to C

Insulin passport would catch prescribing errors as well as dispensing errors, and I personally have experienced way more of the former than I'd like (mostly because it's... Less well trained receptionists that seem to process prescription requests which the doctors sign off blindly - e.g. there are literally dozens of "Lantus" items on their system, and if you get a vial instead of a profiled pen you are in trouble)

Of course, that only helps in you are unable to check whether the insulin is the correct one for you, but in that case you probably shouldn't be managing your own injections anyway.

As for emergency treatment, I have actually discussed that with my consultant - if you are unconscious they put you on an Apidra drip, and she did concede that carrying an insulin passport would not change treatment at all. If anything, I'd say that knowing your insulin doses would be more helpful than the type.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

AMBrennan said:
Insulin passport would catch prescribing errors as well as dispensing errors, and I personally have experienced way more of the former than I'd like (mostly because it's... Less well trained receptionists that seem to process prescription requests which the doctors sign off blindly - e.g. there are literally dozens of "Lantus" items on their system, and if you get a vial instead of a profiled pen you are in trouble)

Of course, that only helps in you are unable to check whether the insulin is the correct one for you, but in that case you probably shouldn't be managing your own injections anyway.

As for emergency treatment, I have actually discussed that with my consultant - if you are unconscious they put you on an Apidra drip, and she did concede that carrying an insulin passport would not change treatment at all. If anything, I'd say that knowing your insulin doses would be more helpful than the type.
Click to expand...


Would Apidra not work out far too expensive to be used as iv drip? I always thought that Actrapid was used.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

I don't know - I was sceptical of the benefits of an insulin passport when i got mine, and i asked my consultant what they (at my local hospital) use when they get an unconscious diabetic who needs insulin, and she told me that they use Apidra sliding scale.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

Have a look at the supporting info pdf on this page which describes why they have introduced it.
http://www.nrls.npsa.nhs.uk/alerts/?ent ... lin%c2%ac'
There have been a large number of errors at all stages of insulin prescription/adminstration/dispensing. The passport is a simple device that they have decided to implement to help avoid these errors.
It's not just aimed as a double check for pharmacists in the community though that's one use of it.
Here are 3 examples they give of when the wrong insulin was dispensed.
Wrong insulin product
The patient was given the wrong insulin by the pharmacist (NovoRapid instead of NovoMix 30), which resulted in significant hypoglycaemia associated with fall and confusion. Fortunately the patient was found by the daughter and brought to hospital.
The patient was prescribed and administrated the wrong type of insulin. Prescribed and administered Humalog (rapid) insulin twice a day and instead of Humalog Mix insulin twice a day. Episodes of severe and persistent hypoglycaemia.
The patient was an inpatient on [a ward]. She attended a drop in session at the diabetes clinic on [date]. Observations were stable. She returned a few days later. The insulin pen she had been given to taken home and which she had been using contained the wrong insulin. The pens were very similar in colour - grey/purple
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As part of the same initiative, they've also made it a requirement that any health care worker who prescribes/prepares/handles or administers insulin has to undergo insulin safety training.
http://www.diabetes.nhs.uk/safety/#
Personally, I'd like an internationally or at least EU accepted version of it. My only 'evidence' (apart from my pump which I suppose is a giveaway) is a badly hand written/ abbreviated French prescription Since I have to spend a fair amount of time in the UK at the moment such an 'official' document could be useful.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

May be Actrapid is no longer available to be used on sliding scales but Apidra is very expensive....

I havent been an inpatient at a hospital for quite a few years but when I was, I was using twice daily insulin and was able to sort out my own insulin dosage and monitor my own bg levels. All the nurses had to do was come round and ask me what my bg levels were. At the time, I was using a lovely bg meter whic knocked spots off what the nurses had so they were happy to leave me to it. I got out of hospital fairly quickly which amazed everyone.

I can see the need for some sort of drug details being available for nurses and doctors to read. There was a well known case a while ago when a nurse administered the wrong insulin because the consultant hadnt written the details that clearly. The nurse adminstered Humalog instead of Humalog Mix. The patient went into a serious hypo coma and spent some time in ICU. Thankfully they didnt die.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

I am specifically referring to cases where the patient is unconscious, and thus unable to manage their own insulin injections - otherwise you could just ask what insulin they are using, making the passport unnecessary.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

It seems to me that this problem, if there is one, can only be the result of:

A. a doctor who is either incompetent (unlikely) or has such bad hand writing that no one can read it (quite common)

B. A pharmacist who is incompetent (unlikely) and needs the help of the patient to do their job efficiently.

No, sorry I dont see how anyone can be given the wrong insulin at all, does this mean when I go and collect a prescription for Metformin I may well be given an overdose of Ketamine by mistake? Are our pharmacists so stupid? I dont think so.

I have always found the worst place to get prescriptions made up is Boots or a big supermarket pharmacy, who always ask me if I am taking any other medication and want to lecture me on this that and the other, I think its just a case of the big pharmacies wanting to cover their backsides because of their own inadequacies.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

I really can't see the problem myself, mistakes do happen after all and anything that safeguards our safety has to be seen in a positive light, I'd happily carry a card and produce it if required.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

AMBrennan said:
I am specifically referring to cases where the patient is unconscious, and thus unable to manage their own insulin injections - otherwise you could just ask what insulin they are using, making the passport unnecessary.
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I would think that if you were unconscious that what insulin you use is of little importance, if you are taken to hospital and found to be hyperglycaemic could they not administer any type of insulin in an emergency? Surely it is the dose not the brand name that is if paramount importance or am I missing something?

As I intimated in my previous post is this not just Boots being pedantic and covering their small donkeys?

Surely any mix up of medication is serious why is it just insulin users being singled out?
 
Re: The Insulin Passport is simply to allow Pharmacists to C

Surely any mix up of medication is serious why is it just insulin users being singled out?
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I don't think that insulin users are being singled out, except in that there have been far too many errors.
I do think that the motivation is protection.
I know exactly what I take and am competent in adjusting my dose. I would also know if I were given the wrong thing but I'm a 'geek' and well informed, I don't believe that's the case with everyone.
If I were unconscious I wouldn't be able to tell someone but if they gave me an insulin dose commensurate with the average for my weight it would be far too high. Insulin passport would be very useful here.
Otherwise
I think there are 2 major problems.
1)Similar names Novorapid, Novomix, Novolin , Humalog, humalin I, S, or Mix.
2) insulin units being confused with ml . if the wrong syringe is dispensed/used the results can be fatal.

Two common errors have been identified: • the inappropriate use of non-insulin (IV) syringes, which are marked in ml and not in insulin units; • the use of abbreviations such as ‘U’ or ‘IU’ for units. When abbreviations are added to the intended dose, the dose may be misread, e.g. 10U is read as 100.
Some of these errors have resulted from insufficient training in the use of insulin by healthcare professional Patient safety incidents Between August 2003 and August 2009 the National Patient Safety Agency (NPSA) received 3,881 wrong dose incident reports involving insulin. These included one death and one severe harm incident due to 10-fold dosing errors from abbreviating the term ‘Unit’. Three deaths and 17 other incidents between January 2005 and July 2009 were also reported where an intravenous syringe was used to measure and administer insulin.
Click to expand...

The other day someone on a forum had a pen that stopped working. They went to a late night chemist and were given some syringes by a late night chemist. Fortunately here the right type of syringe was given but there was a risk that the wrong type of syringe was given. If that had happened would the person have realised they had been given a syringe with the wrong markings?
The passport wouldn't prevent it , nothing could but it might just remind a sleepy pharmacist of the difference.
Sorry I can't see that carrying a card is a problem and as I said earlier, I could do with one.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

It's not just insulin we ask for other things as well a few medications need books to collect.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

Carol...
You get one from your GP/surgery
I have shown mine when going to other clinics where they ask what meds you are taking... ie my eye clinic. Its a lot easier to show the passport than carry around cartons of all your current meds and it means you dont have to remember all the various wierd and wonderful names too.
 
Re: The Insulin Passport is simply to allow Pharmacists to C

I would think that if you were unconscious that what insulin you use is of little importance, if you are taken to hospital and found to be hyperglycaemic could they not administer any type of insulin in an emergency?
Click to expand...
Yes, that was my original point - the carrying an insulin passport will not change treatment at all.
If I were unconscious I wouldn't be able to tell someone but if they gave me an insulin dose commensurate with the average for my weight it would be far too high. Insulin passport would be very useful here.
Click to expand...
A nice idea but the insulin passport does not have dosage information - just the type of insulin.

Edit to add: Have a look at it
 
Ok, so lets say you're really old or blind or just an idiot.? Then yes the card will help, maybe.!? I do not need or want one personally and just had an argument with the pharmacy over accepting one. My question, would be, " are the pharmacies going to stop giving me my insulin because I refuse to be segregated and discrimated against.?
 
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