Few CT hospitals use insulin device misused at Griffin Hospital

Arielle Levin Becker / The CT Mirror

A FlexPen, used to deliver insulin to patients.

Few Connecticut hospitals use the insulin injection devices that were misused at Griffin Hospital, prompting officials last week to recommend that 3,149 patients be tested for bloodborne illnesses.

Twenty-three of the state’s 29 hospitals don’t use the injectors, often referred to as insulin pens. Representatives of those hospitals cited reasons including concerns about cost, wasting insulin and the safety of using the devices in facilities with many patients. The pens contain multiple doses but are intended to be used on a single patient.

Three hospitals confirmed that they use the devices, and two others did not respond to The Mirror’s request for information.

Charlotte Hungerford Hospital in Torrington uses the insulin pens but educates staff about the importance of not using a device on more than one patient, said John Capobianco, vice president of operations and nursing. The hospital has issued four staff reminders on the subject in the past year.

Connecticut Children’s Medical Center in Hartford uses the pens in a limited fashion and they are not shared between patients, according to an official.

And Lawrence + Memorial Hospital in New London has used the pens but is switching away from them this week, spokesman Michael O’Farrell said.

Griffin Hospital also stopped using the devices, called FlexPens, after the misuse was uncovered. CEO Patrick Charmel said Friday that officials had determined that “there is probably no way to prevent misuse” of the devices.

Each FlexPen contains a cartridge with multiple doses of insulin. Patients or health care workers can set it to administer a certain dosage, then reuse the pen for additional doses later.

FlexPens are intended to be used on one patient. But Griffin Hospital officials said that five nurses acknowledged that they had used the same pen on multiple patients or observed another nurse doing it. That prompted the hospital to recommend that anyone who received insulin through a pen while an inpatient at Griffin since September 2008 be tested for hepatitis B, hepatitis C and HIV. (As of 1 p.m. Monday, 104 people had been scheduled for testing and 40 of them had come in for the tests, spokesman Ken Roberts said.)

In the Griffin Hospital case, the risk of infection comes not from needles — the needles were not reused, officials said — but from the possibility that a patient’s blood flowed back into the cartridge and mixed with the insulin that was later administered to another patient. Griffin Hospital officials said the likelihood of disease transmission is very low but that the affected patients should be tested.

Insulin is used to control blood sugar for people with diabetes. While fewer than one in 10 people have diabetes, close to 20 percent of hospitalized patients have the condition, according to a 2010 federal report.

Safety concerns in hospitals

Concerns about the misuse of insulin pens in health care settings are not new. Last year, the Institute for Safe Medication Practices urged hospitals to re-examine the devices and strongly consider alternatives for routine inpatient use.

“All it takes is one or two individuals who are not aware that it is unsafe to place a new disposable needle on a pen used for one patient and use it to deliver a dose of insulin to another patient,” the organization said in an alert. “For example, a new graduate nurse or a temporary nurse may not have received proper training regarding the use of insulin pens, and thus a knowledge deficit may exist. Completely controlling for this is difficult, perhaps even impossible, given that unsafe pen use has persisted despite educational efforts and monitoring.”

A spokesman for Novo Nordisk, which makes FlexPens, said the devices are safe and effective across all settings when used as instructed in the package insert.

“We do feel that it’s appropriately packaged,” spokesman Michael Bachner said Friday.

Kimberly Metcalf, pharmacy director at John Dempsey Hospital and UConn Health, said insulin pens are wonderful for people to use at home, particularly if they have dexterity problems and would struggle with a syringe.

But she said the devices are not conducive to use in hospital settings, where patients don’t administer the medications themselves.

Since it’s usually not clear how long a patient will be in the hospital, using a pen could mean the patient receives — and pays for — many more doses than will actually be administered in the hospital, Metcalf said.

“We don’t want to charge them for a whole pen when they may only use a very small portion of it,” she said.

Storage is also an issue. Metcalf said regulatory requirements call for hospitals to store drugs in a medication room or an automated dispensing cabinet, rather than leaving them with patients.

“If it’s being stored in a medication room and not with the patient, you always worry if someone grabs the wrong pen or things like that,” she said.

Why hospitals use insulin pens

Officials at Charlotte Hungerford Hospital identified the risk of pens being used on multiple patients when they introduced the devices a few years ago, said Capobianco, the vice president of operations and nursing.

So the hospital made sure to educate staff, pharmacists and doctors that the pens were only to be used on a single patient.

The hospital also uses a bar coding verification system with the pens and other medications, requiring nurses to scan both the pen and the patient’s wristband to be sure they match before using the device.

Capobianco said the hospital reminds staff that the devices are for one patient only, using emails, a pharmacy newsletter and including it in in-person education programs. On Friday, after officials learned about the Griffin Hospital situation, another reminder email went out.

Despite the potential risks, Capobianco said the pens have advantages: They allow for accurate dosing and are easy and convenient to use. And because patients often use the pens at home, using them in the hospital allows patients to become familiar with them before leaving the hospital.

Similarly, at Connecticut Children’s, diabetes specialists work with patients and their families so they learn to use the FlexPens.

At Lawrence + Memorial Hospital, officials are confident that the pens had been used correctly because of education and training, as well as daily safety huddles, O’Farrell said.

“That said, with an approach of being the safest hospital we can possibly be, we are making the switch this week away from pens, too,” he said.

Hospitals that don’t

Two hospitals did not respond to The Mirror’s requests for information about insulin pen usage: Milford Hospital and St. Vincent’s Medical Center in Bridgeport.

Of those that don’t use insulin pens, some, including Bristol Hospital, cited the cost of the devices.

Others cited safety concerns. At Waterbury Hospital, the devices had been discussed, but pharmacists and physicians didn’t favor them, spokeswoman Patty Charvat said. “They felt that the safety concerns outweighed their benefit,” she said.

But the pens are used at some Waterbury Hospital outpatient clinics and given to patients for use at home, she said.

Similarly, Yale-New Haven, Bridgeport and Greenwich hospitals — which share a parent company — don’t use the devices, but a small number of outpatient clinics give prescription insulin pen samples to teach patients to use them at home, spokesman Mark D’Antonio said. And some patients might bring their own pens from home to use when hospitalized, he added.

Hartford Hospital initially decided against using the pens because of cost, spokeswoman Rebecca Stewart said. Officials reconsidered about nine years ago and conducted a trial, but nurses were not in favor of them, Stewart said. “Since then there had been safety concerns,” she said.

Eastern Connecticut Health Network’s facilities, Manchester Memorial and Rockville General hospitals, don’t use the pens because of concerns about the waste associated with them, spokeswoman Rosemary Martocchio said, noting that the hospitals don’t send medications home with patients.

Johnson Memorial Medical Center does not use the pens, but Evergreen Health Care Center, an affiliated nursing home, does. The nursing home follows the manufacturer’s guidelines and uses each device on only one patient, according to the hospital.