INSULIN Mixed Type Prep: Skills Stack Procedure

Verbalize ALL steps

1st

Verify physician’s order; identifies current blood glucose value

2nd

Selects insulin syringe with small gauge needle (25-27 gauge)

3rd

Identifies correct prescribed insulin types & verifies expiration date on medication vial

4th

Rolls vial modified insulin (cloudy) to mix

5th

Perform Hand hygiene

6th

Swabs top of both insulin vials with alcohol and allows injection stoppers to dry7t

7th

Injects volume of air equal to prescribed insulin dose volume FIRST into the vial of modified insulin (cloudy vial) without allowing needle to touch solutions; removes needle from vial 8

8th

With the same syringe, inject volume of air equal to prescribed insulin volume into the vial of unmodified (regular insulin) clear vial

9th

Withdraws correct volume for dose unmodified (regular) insulin (clear vial); with needle remaining in vial, verifies dose with 2nd nurse (high alert medication)

10th

Withdraws needle from vial; uses scoop-method to cover needle with cap (protects exposed needle in preparation for transport to patient’s bedside)

11th

Verbalizes maximum time delay from mixing to administration (5 minutes: regular insulin binds with modified (NPH) insulin, thus reducing the action of the regular insulin)