Dispensary Standard Operating Procedure Insulin: Order, Storage and Dispensing

DISPENSARY
Standard Operating Procedure

INSULIN: ORDER, STORAGE AND DISPENSING
Purpose
To ensure that insulin products including equipment are ordered, stored and
dispensed in accordance with the drug safety recommendations.
Scope
The procedure covers the way in which insulin is ordered, stored and
subsequently dispensed by a dispensary. It covers aspects of pharmaceutical
assessment, assembly, labelling, accuracy checking and transfer to the
patient.
Procedure / process
P1. Ordering and Storage and Preparation of Dispensing Insulin
 Most insulins can be ordered from the appropriate wholesaler when

necessary. On receipt of the order it MUST be put straight into the
fridge and stored between 2-8°C according to the cold chain process.
 Check the patient medication record to see if they have had the insulin
before. The patient may have a patient passport (England and Wales)
or a medication chart which states the relevant medication details.
 Check the patient’s drug history to establish if they are due a diabetic
review. If they are, ask the [insert appropriate staff member] to make
them an appointment. If they have had a recent review check that no
adjustments have been made to their diabetes management plan,
resulting in a dosage change.
 Check for new medications that may have a possible impact on the
dosage of the insulin.
 If any discrepancies are present the GP or diabetes specialist nurse
must be referred to before continuing with the dispensing process.
 Record any changes electronically on the patient medication records.
P2. Dispensing the prescription

 When dispensing the drug, interruptions should be kept to a minimum.
 Read the prescription through, including the patient’s personal details
as well as drug strength, quantity and dosage.
 Select the correct insulin(s) and injecting products if required. Be aware
that different insulin packaging may look very similar and also insulin
names can be possibly misinterpreted.
 The dispenser should then carefully check the dosage. Most insulins
are available in a strength of 100U/1ml or 500U/1ml
DISPENSARY
P3. Check the product –

 Firstly read the drug name on the packet and the expiry date.
 The next stage of the process is to check the insulin strength on the
packaging.
 All packs must be checked if using more than one pack.
 Check that the pack contains the relevant PIL, or that a leaflet is
supplied; these can be downloaded from the Internet.
P4. Check the LABEL -

1. The label must be checked against the prescription (not the item which
has been dispensed) to ensure that it has the correct patient details,
the correct medication name and strength, total quantity and correct
dosage.
2. The usage Instructions and dosage instructions on the label must be
checked so that it corresponds with the prescription.
3. Always label with the full word “unit” to avoid any misunderstanding as
a U could very well be misinterpreted as an 0, so potentially it may
result in an overdose of insulin.
P5. Complete the checks

 After completing the accuracy check of the product you should initial
the label.
 Any error which has been found during these procedures must be
brought to the attention of the dispensary manager and doctor. Then a
near miss log should be completed.
 If other items are on the same prescription, count how many, then as
you are bagging up the medication double check all the drugs and final
medication quantity.
 Check that you have not included any stock containers in the bag.
 Store final labelled, bagged up product in the fridge (according to the
cold chain SOP) awaiting collection from the patient. Although not a
legal requirement it is good practice to bag up the labelled insulin in a
clear polythene bag after dispensing, instead of a regular paper bag.
Then when handing out the medication you can confirm with the patient
that the insulin which has been dispensed is correct.
DISPENSARY
 If there are other items mark the bag with a fridge sticker so that on
giving out the prescription nothing is forgotten and that all the
necessary advice is given.
 On giving out the medication check the patients address, as in
accordance with the dispensary SOP: Transferring dispensed items to
patients.
 Ensure the patient signs the prescription and the medical exemption
box is crossed and proof asked for. If they have no evidence of the
exemption the box on the back of the prescription must be crossed.
 If a representative of the patient is collecting the prescription, ensure
they complete their details on the back of the prescription - Usually
marked (E) and evidence of the medical exemption should be
requested.
 If the patient is collecting the prescription at a later time make sure it is
marked insulin/fridge item, so that relevant advice can be given.
Ensure that the patient or representative is aware of the storage
requirements.
Responsibility for Insulins

All dispensers are responsible for the safe dispensing, ordering and storing of
insulin, but the GP, as the responsible person has overall responsibility for
ensuring that safety procedures are in place and are being adhered to.
Access to Insulins
Only dispensers and doctors can have access to the dispensary fridge. The
dispensary must be locked if there is no dispenser present.
Reporting of adverse events

All adverse events regarding the dispensing of insulin must be reported to the
responsible person and an adverse event form completed. This will be
discussed at the next available clinical governance meeting. If appropriate,
serious adverse events will be reported in an anonymised format to the local
contracting organisation.
Review procedure
This procedure will be reviewed following:
 Changes in the law affecting dispensing and storage of insulin.
 Changes in DDA or other guidelines affecting the dispensing process
 Change of staff
 Any adverse dispensing incident
 In the absence of any of the above, on or before the date shown below.
DISPENSARY
Known risks
 Failure to correctly confirm with patients the drug usage and storage
 Distractions or interruptions
 Working long hours without a break
 Quieter periods (research shows that fewer errors occur when the
dispensary is busy)
 Illness/lack of focus/personal problems
 Over-reliance on the person dispensing the medication
 Self-checking
 New staff, locums, etc.
 Dosage Instructions on the label unclear
Advisories
Patients should be advised that when they need to dispose of their used
needles/lancets, a sharps bin should be requested on prescription. When the
sharps bin is full, the SEALED box is to be returned to the dispensary for safe
disposal/Incineration.
If needed counsel the patient with regards to lifestyle and weight management
and make them aware of any clinics offered at the surgery which may benefit
them. Also with regards to their condition ensure that they are aware of the
signs and symptoms of hypo/hyperglycaemia and what should be done if they
experience them.
If the dispensed item is for a care home ensure:

 care home staff are aware of all the storage requirements and possible
complications with the patient’s condition
 all insulin-dependent patients understand when to check their blood
glucose and what the results mean. If there is ANY confusion at all, an
appointment should be offered with the GP or diabetes specialist nurse
to prevent any problems.
I have read and understood this standard operating procedure:
Name Position held Signature Date

DISPENSARY
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Effective from:
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Date of preparation:
Date of review:
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DISPENSARY

Standard Operating Procedure

 Most insulins can be ordered from the appropriate wholesaler when

P2. Dispensing the prescription

P3. Check the product –

P4. Check the LABEL -

P5. Complete the checks

Responsibility for Insulins

Reporting of adverse events

If the dispensed item is for a care home ensure:

I have read and understood this standard operating procedure:

Name Position held Signature Date

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