title: A stewardship intervention program for safe medication management and use of antidiabetic drugs.
abstract: BACKGROUND
  Diabetes patients are complex due to considerations of polypharmacy, multimorbidities, medication adherence, dietary habits, health literacy, socioeconomic status, and cultural factors. Meanwhile, insulin and oral hypoglycemic agents are high-alert medications. Therefore it is necessary to require a multidisciplinary team's integrated endeavors to enhance safe medication management and use of antidiabetic drugs.
  
  
  METHODS
  A 5-year stewardship intervention program, including organizational measures and quality improvement activities in storage, prescription, dispensing, administration, and monitoring, was performed in the Second Affiliated Hospital of Zhejiang University, People's Republic of China, a 3,200-bed hospital with 3.5 million outpatient visits annually.
  
  
  RESULTS
  The Second Affiliated Hospital of Zhejiang University has obtained a 100% implementation rate of standard storage of antidiabetic drugs in the Pharmacy and wards since August 2012. A zero occurrence of dispensing errors related to highly "look-alike" and "sound-alike" NovoMix 30(®) (biphasic insulin aspart) and NovoRapid(®) (insulin aspart) has been achieved since October 2011. Insulin injection accuracy among ward nurses significantly increased from 82% (first quarter 2011) to 96% (fourth quarter 2011) (P<0.05). The number of medication administration errors related to insulin continuously decreased from 20 (2011) to six (2014). The occurrence rate of hypoglycemia in non-endocrinology ward diabetes inpatients during 2011-2013 was significantly less than that in 2010 (5.03%-5.53% versus 8.27%) (P<0.01). Percentage of correct management of hypoglycemia by nurses increased from 41.5% (April 2014) to 67.2% (August 2014) (P<0.01). The percentage of outpatient diabetes patients receiving standard insulin injection education increased from 80% (April 2012) to 95.2% (October 2012) (P<0.05). Insulin injection techniques among diabetes outpatients who started to receive insulin were better than indicated in data from two questionnaire surveys in the literature, including the percentage checking injection sites prior to injection (85.6%), priming before injection (98.1%), rotation of injecting sites (98.1%), remixing before use (94.5%), keeping the pen needle under the skin for >10 seconds (99.4%), and using the pen needle only once (88.7%). On-site inspection indicated of great improvement in the percentage of drug-related problems in the antidiabetes regimen between the first and second quarter of 2014 (1.08% versus 0.28%) (P<0.05).
  
  
  CONCLUSIONS
  Quality improvements in safe medication management and use of antidiabetic drugs can be achieved by multidisciplinary collaboration among pharmacists, nurses, physicians, and information engineers.
authors.affiliation: Clinical Nurse Specialist Section, Division of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
authors.forename: Rui-yi
authors.initials: RY
authors.lastname: Zhao
authors.affiliation: Clinical Nurse Specialist Section, Division of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
authors.forename: Xiao-wen
authors.initials: XW
authors.lastname: He
authors.affiliation: Clinical Nurse Specialist Section, Division of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
authors.forename: Yan-min
authors.initials: YM
authors.lastname: Shan
authors.affiliation: Geriatric VIP Care Ward, Division of Nursing, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
authors.forename: Ling-ling
authors.initials: LL
authors.lastname: Zhu
authors.affiliation: Department of Pharmacy, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China.
authors.forename: Quan
authors.initials: Q
authors.lastname: Zhou
mesh_terms: D002681:China; D003920:Diabetes Mellitus / Q000188:drug therapy*; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control / Q000628:therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008508:Medication Errors / Q000517:prevention & control; D054539:Medication Therapy Management / Q000458:organization & administration* / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration; D010607:Pharmacy Service, Hospital / Q000458:organization & administration* / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration*
chemical_list: D007004:Hypoglycemic Agents
keywords: diabetes nursing specialists; injection technique; insulin; medication errors; oral hypoglycemic agents; pharmacy; quality improvements