Comparative Storage and Utilization Analysis of Insulin Across Inpatient Hospital Settings

Insulin is the primary medication used by health systems across the nation to provide glucose control to those patients who need it. As this medication is generally available in a multi-dose vial, proper administration techniques should be used to minimize waste and optimize the cost effectiveness of the drug. Even though dosing guidelines for hospital use of insulin exist each institution has the opportunity to choose their administration technique. In this paper I will to identify administration characteristics utilized by four different hospitals in the central Kentucky area, compare and contrast those techniques through data collection, and analyze the findings to determine the process that reduces the most waste and allows for the most cost effective use of the drug. This study focuses on insulin use processes at the following hospitals: Good Samaritan Hospital (Good Sam), the University of Kentucky Chandler Medical Center (UKCMC), Baptist Health-Richmond (BH), and the Lexington Veteran’s Affairs Hospital (VA). The purpose of the study is to gain an understanding of the use of insulin at Good Sam by collecting data over a two-week period and comparing that data to each of the other three hospitals. The data for these three hospitals was collected and studied throughout the completion of rotations at each institution. This comparison will allow for the identify of areas for improvement within Good Sam’s current insulin management process. Data collection measures included their insulin storage on the inpatient floors, insulin administration process, insulin purchasing process, and insulin waste process. Data collected at Good Sam was used to determine the amount of insulin waste (in milliliters) being collected each day over the two-week period. An average of that value was obtained and extrapolated to determine an approximate waste per six months. Using the current purchasing data for insulin, I determined the approximate cost of the insulin waste produced at Good Sam. Utilizing the knowledge of the insulin management process at Good Sam I was able to spend the next 18 weeks analyzing three other hospital’s insulin management process to determine ways to better utilize the insulin at Good Sam and to develop strategies to reduce insulin waste. This study serves as the basis for several recommendations to modify the insulin management process used at Good Sam. System wide nursing education on the proper technique to prepare insulin doses will be the foundation of these modifications. This education will include the preparation of the doses to occur at the Pyxis machines (automated dispensing cabinets) rather than the bedside. This minimizes the opportunity for distraction and increases the likelihood that vials will be replaced to their appropriate location to reduce waste. An additional recommendation includes storing vials of the of the insulin types that are used less frequently unopened in the fridge until needed. This will minimize the loss of product due to product expiration

Medical Therapies for Uterine Fibroids - A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

BACKGROUND: Uterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence. PURPOSE: To determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence. STUDY SELECTION: Two authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013. DATA EXTRACTION: Two authors independently extracted data from identified studies. DATA SYNTHESIS: A Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence-Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI) were calculated. RESULTS AND LIMITATIONS: A total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes. CONCLUSIONS: There is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed