Does the implementation of self-administration policies for insulin improve patient safety in the hospital inpatient setting? A scoping review
Authors: Davidson E , Jones T , Baqir W , Fenwick K 
Published: November 2023

Abstract

Introduction
Self-administration schemes can have significant impact on a patient’s management and treatment of specific diseases. Implementing the self-administration of insulin for inpatients is believed to increase patient’s knowledge, understanding, independence and confidence regarding medication to improve outcomes. This study identifies the limited knowledge and access to self-administration schemes for diabetes.

Aim
The aim of this scoping review is to collect and review relevant literature surrounding inpatient insulin self-administration schemes and to identify the impact this scheme has on knowledge, confidence, independence, satisfaction, costs and workload for patients, hospitals and staff. This scoping review further aims to highlight the reported limitations regarding self-administration and identify the potential gaps in the evidence-base.

Methods
Keywords were searched on MEDLINE (1946 to October Week 4 2022), EMBASE (1974 to 2022 Week 43), Scopus, Web of Science, CINAHL and Google Scholar from October 6th, 2022, to November 8th, 2022. The title, abstract and citations were initially screened using the inclusion and exclusion criteria. Included literature was then screened by a second reviewer. The identified literature described and evaluated inpatient insulin self-administration schemes and summarised according to author and study design. This scoping review did not require ethical approval as it was including information and studies freely available for public domain. Newcastle University Pharmacy Department.

Results
Among the 1,159 literature sources identified, 16 literature sources were included in the scoping review. A systematic review and meta-analysis was initially considered but yielded due to the heterogeneity of literature in study design. Nine quantitative and seven qualitative studies assessed individual patient and staff views. They were assessed in ranging time frames up to eight months. Literature evaluated the knowledge, understanding and compliance of patients relating to administration and drug regimens which were measured via questionnaires and interviews. Studies identified short-term costs to outweigh long-term benefits. The majority of patients and staff were significantly satisfied with the implementation of self-administration schemes.

Discussion/Conclusion
The implementation of insulin self-administration schemes for inpatients has shown to support patient health and safety, increasing knowledge and compliance. Literature continues to identify the need for extra support and maintenance from healthcare professionals to control diabetes. Self-administration schemes may continue to advance with increased support and engagement. Study limitations were identified to further acknowledged the advancements in time frames, support and sample size and selection for participants, supporting the advancements in self-administration schemes.

References
1. Wright J, Emerson A, Stephens M, Lennan E. Hospital inpatient self-administration of medicine programmes: a critical literature review. Pharmacy World and Science. 2006;28(3):140.
2. Muhammad K, Khan T, Nisar Ur R, Khan Z, Subhan F. Knowledge and attitude regarding insulin self-administration among diabetic patients: a cross-sectional study in a teaching hospital of Khyber-Pakhtunkhwa, Pakistan. Drugs & Therapy Perspectives. 2020;36(6):266-72.
3. Gangopadhyay KK, Ebinesan AD, Mtemererwa B, Marshall C, McGettigan AT, Cope A, et al. The timing of insulin administration to hospital inpatients is unsafe: Patient self-administration may make it safer. Practical Diabetes International. 2008;25(3):96-8.