Mixing Insulin

Verify the health care provider's orders. Verify the Six Rights of Medication Administration: patient, drug, dose, time, route, documentation. Check the medication order in the EHR. Calculate the correct dose of medication that you will be administering (verbalize the dose units). This may be done after blood glucose is assessed. Introduce yourself to the patient. First name is appropriate. Provide patient privacy. Note: If the patient has family present, ask the patient if family may stay while discussing HIPPA protected information. Identify the patient with at least two identifiers. Ask the patient if they have any known allergies (food, medication, seasonal, other). Determine the patient's blood glucose level. Verbalize the level and when their next meal is going to be. Inform the patient of the purpose of your visit. Discuss the insulin medication, its action, uses, and common side effects and list them. In addition, let the patient know that they may feel a slight burning or stinging sensation while administering the injection. Instruct the patient to report any adverse effects and list them. Allow the patient to ask any questions. Note: Research adverse effects of the medication, potential adverse effects, and how long after administration it may occur. Perform hand hygiene and apply clean gloves. Select the ordered insulin from the medication cart or automated medication dispensing unit. Compare the insulin label with the Medication Administration Record. Check the expiration date on the vial. If the medication has been refrigerated, allow it to come to room temperature before administering it. Inspect the insulin for changes that may indicate a loss of potency, such as clumping, frosting, precipitation, or altered color or clarity. If a correction scale or sliding scale is used, obtain a current bedside blood glucose level. Check the EHR/MAR and note the correct amount to draw up based on the patient’s current reading. When mixing rapid or short acting insulin with intermediate acting insulin, prepare as follows: Verify the orders with the MAR. Preparing medicine: Calculate the total volume of insulin you will need. Ask another RN to verify. Roll the vials between your hands. Wipe off the top of both insulin vials with an alcohol swab. Filling the syringe with medication: With the cap still on, pull back the plunger to the line on the syringe for the prescribed dose of intermediate-acting (NPH) insulin to be administered. Insert the needle into the vial of intermediate acting insulin. Inject a volume of air equal to the amount of intermediate acting insulin into the vial. Do not let the tip of the needle touch the solution. Remove the syringe from the vial without aspirating the medication. With the same syringe, pull back the plunger to the line on the syringe for the prescribed dose of short-acting regular insulin to be administered. Insert the needle into the short-acting insulin vial. Inject the volume of air equal to the amount of short acting insulin into this vial, then invert the vial and draw the correct number of units of insulin into the syringe. To remove air bubbles from the syringe, remove the syringe from the vial. Tap the syringe with your finger to move air bubbles to the top, then push gently on the plunger to push the air bubbles. Confirm the dose of short-acting insulin by comparing it to the EHR/MAR again. Determine the point on the syringe that the combined units of insulin should reach by adding the number of units of both insulins together. Verify the combined dose against the EHR/MAR again. Place the needle back into the vial of intermediate-acting insulin. Be careful not to push the plunger and inject insulin already in syringe into the vial. Invert the vial and carefully draw the desired amount of insulin into the syringe. Do not overdraw insulin into the syringe. Withdraw the syringe from vial and recheck and verify the number of units in the syringe. If insulin is prepared away from the patient's bedside, label the syringe with the name and dose.