Outpatient Insulin-related Adverse Events Due to Mix-up Errors: Findings from Two National Surveillance Systems, United States, 2012-2017

Details

• Alternative Title:
  Pharmacoepidemiol Drug Saf
• Personal Author:
  Geller, Andrew I. ; Conrad, Ariane O. ; Weidle, Nina J. ; Mehta, Hina ; Budnitz, Daniel S. ; Shehab, Nadine
• Description:
  Purpose: ; We used data from two public health surveillance systems for national estimates and detailed descriptions of insulin mix-up errors resulting in emergency department (ED) visits and other serious adverse events to help inform prevention efforts. ; Methods: ; ED visits involving patients seeking care for insulin medication errors collected by the NEISS-CADES project in 2012-2017 and voluntary reports of serious insulin medication errors submitted to the U.S. Food and Drug Administration (FDA) in 2016-2017 were analyzed. National estimates of insulin product prescriptions dispensed from retail pharmacies were obtained from IQVIA National Prescription Audit. ; Results: ; Between 2012 and 2017, based on 514 NEISS-CADES cases, there were an estimated 5,636 (95% CI, 4,143-7,128) ED visits annually for insulin mix-up errors; overall, over three-quarters (77.5%; 95% CI, 71.6%-83.3%) involved taking rapid-acting instead of long-acting insulin. Between 2012 and 2017, the proportion of mix-up errors among all estimated ED visits for all insulin errors decreased by 60%; concurrently, the proportion of pens among all insulin package types dispensed increased by 50%. Among 58 voluntary reports submitted to FAERS, over one-half (56.9%) of cases involved taking rapid- instead of long-acting insulin. Among 27 cases with documented contributing factors, approximatley one-half involved patients having difficulty differentiating products. ; Conclusions: ; Among all ED visits for insulin errors collected by NEISS-CADES in 2012-2017, the proportion involving mix-up errors has declined. Continued reductions may require additional prevention strategies, including improving insulin distinctiveness, particularly for rapid- vs. long-acting insulins. Ongoing national surveillance is important for identifying the impact of interventions.
• Subjects:
  • Emergency Service, Hospital
  • Humans
  • Insulin
  • Medication Errors
  • Outpatients
• Keywords:
  • Insulin
  • Medication Errors
  • Drug-related Side Effects and Adverse Reactions
  • Hypoglycemia
  • Health Literacy
  • Drug Packaging
• Source:
  Pharmacoepidemiol Drug Saf. 30(5):573-581
• Pubmed ID:
  33625786
• Pubmed Central ID:
  PMC9540655
• Document Type:
  Text
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Genre:
  Journal Article
• Volume:
  30
• Issue:
  5
• Download URL:
  https://stacks.cdc.gov/view/cdc/121735/cdc_121735_DS1.pdf
• File Type:
  [PDF - 176.56 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:6d3583dbbaabc0c440113b04a72b6761a89d952b0e4ed6687d9d7ee7d8f04f5062eb70a8c5b05f8704bae24027204a14e15444a8f712730a4d6457cd227ca18a