For patients with diabetes in settings where long-term care pharmacy is used to support medication management, administering insulin is a common responsibility of a facility’s nursing staff. Insulin is a critical treatment for these patients, so it’s important that nursing teams stay up to speed on best practices for the insulin injection process – from choosing the best injection site to their care after administration. Read on for our quick and easy guide to safely managing the insulin injection process from start to finish.

Choosing an insulin injection site

Insulin injection sites are not all created equal when it comes to rates of absorption. For example, the absorption rate from the abdomen is more predictable and consistent than that of the arms, thighs, or buttocks. However, absorption rates can also vary within the same area. A few things to keep in mind:

  1. Injecting into the same spot repeatedly may lead to lumps or thickened tissue that can delay insulin absorption or cause discomfort. Make sure to rotate and track injection sites to avoid overusing certain areas. 
  2. When injected into fatty tissue rather than muscle or bone, the body absorbs insulin more effectively. Areas of the body with a higher fat concentration, such as the abdomen, buttocks, or thighs, are ideal injection sites, as the body absorbs insulin most effectively in these areas.
  3. Steer clear of areas with prominent bones or scars.

Safely navigating the insulin administration process

Once you’ve determined the site for your insulin injection, it’s time to administer the drug.

  1. Before giving an insulin injection, always wash your hands with soap and water to reduce the risk of infection. Once your hands are clean, you can use an alcohol pad to clean the injection site that you’ll be using Avoid touching anything else until after you’ve administered the injection.
  2. Hold the injection device at an upright angle to prevent insulin leakage during the injection. Remove the cap from the needle and check the insulin for any particles or change in color before use. If you notice anything strange, do not use the insulin.
  3. Insert the needle at a 90-degree angle to the skin. In thinner patients, it is recommended to use an angle of 45 degrees to reach the subcutaneous fat layer.
  4. Make sure to inject insulin slowly for a better absorption rate. Once the injection is complete, gently remove the needle and use an alcohol pad to press down on the injection site to stop any bleeding.
  5. Always dispose of used needles in a sharps container. Do not throw used needles in the garbage or recycling bin.

Care after administration

  1. Avoid massaging insulin injection sites. After injecting insulin, it is tempting to rub or massage the site to alleviate pain or improve insulin absorption. Unfortunately, doing so can stimulate blood flow and interfere with insulin absorption. It can also cause bruising or bleeding, which may affect blood sugar levels. Instead, leave the injection site alone for a few seconds to absorb the insulin fully.
  2. Keep insulin injection sites clean and hygienic. Cleaning the skin with alcohol swabs before injecting insulin can help remove bacteria and ensure that the injection site is clean. However, it is important not to overuse alcohol swabs as they can irritate the skin and cause dryness. Also, be sure to let the skin dry before injecting insulin to prevent stinging or discomfort.

At Grane Rx, we are committed to supporting the staff in skilled nursing facilities. Through our education programs, we empower nursing teams to navigate the complexities of blood sugar management effectively. By enhancing understanding of the insulin injection process, staff can reduce complications resulting from high or low blood sugar levels.

Learn more about our long-term care pharmacy services and how we could partner with your organization by calling (866) 824-MEDS (6337) or emailing

COVID-10 Vaccine Updates 

On August 23, 2021, the FDA approved the first COVID-19 vaccine. The Pfizer- BioNTech COVID-19 vaccine is now approved for individuals 16 years of age and older and will be marketed as Comirnaty. Individuals that are 12 to 15 years in age are still able to get the vaccine at this time under the emergency use authorization (EUA). With this approval, it confirms that the vaccine is safe, effective, and meets manufacturing quality. 

COVID-19 Booster shots are now becoming available!

The COVID-19 vaccines have shown to be effective in decreasing hospitalization, severe illness, and death. Overtime, individual’s protection to the virus may decrease, especially with the new variants such as the Delta variant. A booster shot would ensure that you remain protected. This fall, only those that received the Pfizer-BioNTech or Moderna COVID-19 vaccines would be eligible to receive a booster shot.

Who will be eligible for a booster shot?

Patients that received their second dose of Pfizer-BioNTech or Moderna vaccine 8 months ago will be eligible. The plan will be to start administering the booster shot in the fall. 

Who will get the booster shot first? 

Similar to the initial rollout of the vaccine, booster shots will be offered to those that are at the most risk for COVID-19. These individuals include healthcare workers, long-term care residents, and other older adults. 

What if I received the J&J/Janssen COVID-19 vaccine?

While there is no booster shot currently available for those that received the J&J/Janssen COVID-19 vaccine, it is expected that there will be one available next year. Since the J&J/Janssen vaccine was offered to the public after the Pfizer-BioNTech and Moderna vaccine, the data is not yet available. 

What is the difference between a booster shot and an additional dose?

A third dose of the vaccine is for certain individuals that are immunocompromised and did not build enough protection from the first two doses of the vaccine. These individuals can receive the vaccine at least 28 days after second dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines. 

On the other hand, booster shots are being offered because individuals were once fully protected from COVID-19, but now that protection is starting to decrease. The Pfizer-BioNTech and Moderna COVID-19 booster shots will be offered to individuals 8 months after their second dose. 

Information is accurate as of 8-29-2021

Vaccine Information Center

J&J Vaccine Overview

Submission and Approvals

J&J Information Center

Vaccine Type

Efficacy Rate

Common Adverse Events 

Storage Recommendations

J&J Vaccine FAQ

Q. How does the viral vector vaccine work?

A. Viral vectors use a modified version from a different virus to deliver information to cells. The viral vector COVID-19 vaccine uses a different, harmless virus to enter cells in the body in order to produce the spike protein of the COVID-19 virus. This spike protein is harmless

Similar to the mRNA vaccines effects, our cells present the spike protein on its surface so that our immune system recognizes this foreign protein and can start producing antibodies against it

Q. Can I get the vaccine if I’m pregnant or breastfeeding?

A. There is currently insufficient data to determine whether there are vaccine-associated risks in those who are pregnant or breastfeeding.

However, the CDC states that if you are pregnant you may choose to be vaccinated as there is no evidence that the antibodies formed from COVID-19 vaccination can cause any problem with pregnancy. The CDC is continually updating its guidance on COVID-19 vaccination

Q: Are there any contraindications to the vaccine? 

A. Individuals with a known history of severe allergic reaction to any components of the Janssen COVID-19 vaccine are contraindicated

Q: Can the Janssen COVID-19 vaccine be used to complete a vaccination series initiated with another COVID-19 vaccine?

A. There is no data available regarding the use of the Janssen COVID-19 vaccine to complete another vaccination series

Q: Can the Janssen COVID-19 vaccine be administered at or around the same time as other vaccines?

A. There is currently no data available regarding the use of this vaccine with other vaccines

For more information about all of the COVID-19 Vaccines currently available, please visit the Grane Rx Vaccine Information Center.

Vaccine Information Center

Q: What are the benefits of receiving a COVID-19 vaccine? 

A: Getting vaccinated will decrease your risk of contracting and getting sick from the COVID-19 virus like the influenza vaccine decreases your risk of contracting the flu virus. The benefits of receiving the vaccine far exceed the risks of contracting COVID-19 and potentially having serious, life-threatening or life-long complications. Being vaccinated will help stop the pandemic in combination with following CDC guidelines.

Q: Vaccines usually take years to develop. The COVID-19 vaccines have been developed in under a year, how do I know they are safe? 

A: The Phase 3 trials that took place for the COVID-19 vaccines were of similar size and nature to the Phase 3 trials that have taken place for other vaccines and medications. 

Here is what the process looks like:

The data gathered from Phase 3 trials is subject to extensive review by independent experts in multiple areas of science including immunology, statistics, infectious diseases, virology, and vaccinology. 

Once a pharmaceutical or biotechnology company submits a vaccine to the FDA for Emergency Authorization Use, it undergoes another round of review by the Vaccine and Related Biologics Product Approval Committee (VRBPAC). This committee then provides advice to the FDA before any decision is made. 

Once the FDA decides to approve a vaccine, it goes through another round of review by the Advisory Committee on Immunization Practices (ACIP). The ACIP then makes recommendations to the CDC on who should and shouldn’t get the vaccine.

Finally, once a vaccine is approved and individuals are deciding whether to get it, they will have access to information that summarizes the clinical trial findings. This includes data related to any side effects found during the trials and who should or should not get the vaccine. 

Authorized Vaccines (as of 2/18/21)

Q: Can you get sick from receiving the SARS-CoV2 protein or the modified virus through the vaccine? 

A: No, the proteins will not make you sick, however you may experience side effects from the  vaccine. 

Q: Will I experience side effects from receiving the COVID-19 vaccine?

A: Yes, it is possible to experience side effects from these vaccines much like the annual influenza vaccine or any other vaccination. These side effects can range from a sore arm to feeling warm or muscle aches. These are signs that an immune response is building in your body and are completely normal. Experiencing these side effects does not mean you have a mild form of the virus

Q: Will I have to receive multiple shots in order to gain the full immunity to COVID-19? 

A: The Pfizer vaccine and Moderna vaccine both require the use of two  vaccinations to gain the full effect. The Johnson & Johnson vaccine (currently under FDA review for emergency use authorization) will require a single vaccination.

Q: Should I get the vaccine if I already had COVID-19? 

A: Yes, it is recommended. Previous COVID-19 infection is not considered a contraindication to receiving the vaccine. Antibody testing is not necessary or recommended prior to receiving the COVID-19 vaccination per CDC guidance.

Healthcare workers who tested positive for COVID-19 within the previous 90 days have a choice to delay receiving the vaccine until near the end of the 90 days to allow other healthcare workers to get vaccinated first. There is evidence suggesting reinfection of COVID-19 is not common 90-days post initial infection.

Q: Will the COVID-19 vaccine make me test positive for COVID?

A: No, the COVID vaccine will not cause you to test positive for a viral test. You may however test positive if the test is measuring antibodies. This is the desired result of the vaccine. The goal of vaccination is for your body to produce antibodies to be ready to fight COVID-19 once you are exposed.

Q: Once I receive the vaccine do I still have to wear a mask and follow social distancing  guidelines?

A: Yes, it is recommended that even if you receive the vaccine that you still follow all guidelines set by the CDC. This is because it will take time to immunize the entire country to the point where there is no concern of transmission.

For Grane Rx’s full vaccine FAQ please visit our COVID-19 Vaccine Information Center.

Vaccine Information Center
2021 Healthy Living Calendar

Analyzing Medication Administration Times Moving Forward: Gain Workflow Efficiencies and Resident Safety

While evaluating and optimizing medication administration practices are especially important in the short term to prevent transmission of COVID-19, in the long term, these strategies help make workflow more efficient, medication regimens safer for residents, and prevent the spread of other microbes overall.

Consolidating Medication Administration: To help determine the most efficient strategy in administering medications, analyze the way in which a resident’s medications are currently administered. Look for ways to reduce the number of visits to the resident which require direct or very close contact (such as medication administration), thereby allowing time for other care related tasks or socialization opportunities as well as reducing pill burden for residents.

Flex Time Administration: For medications that do not need to be administered at very specific times, consider switching to a flexible medication administration schedule or the universal medication schedule to minimize the number of medication passes per day. These schedules allow for more flexibility in administration of medications throughout the day for the nursing staff and are generally more resident-friendly.

For example, under the universal medication schedule, the directions “take one tablet twice daily” may become “take one tablet in the morning and one tablet at bedtime”. Medications with directions written according to the universal medication system at a certain time of day can then be given together in one administration time rather than at separate, specific times.

For example, a medication that was originally scheduled to be administered at 10:00 AM and another scheduled to be administered at 9:00 AM can be given at the same time “in the morning”, as long as there are no interactions or restrictions. This reduces the number of medication passes from two to one.

Assess for Unnecessary Medication: As mentioned previously, it is important to actively and continuously work with other healthcare professionals on your team to make sure the resident’s medication regimen does not have any unnecessary medications. Reducing the amount of medications in a resident’s regimen in turn reduces the frequency of administration times.

Eliminating unnecessary medications not only minimizes transmission of microbes, but also minimizes the opportunity for medication interactions and adverse effects. Unnecessary medications may complicate medication regimens and increase pill burden. The more medications in a resident’s regimen, the more chance of a resident experiencing adverse effects and potential medication interactions.

Prevention is an Outcome:  in the older adult population, medication management can go a long way in preventing falls, potential visits to the emergency room, and reducing costs.

The above medication management and administration strategies can help reduce transmission of microbes and allow for efficient and safe medication administration overall. Grane Rx consultant pharmacists can help implement these strategies as they have the ability to analyze your facility medication pass distribution and resident pill burden to help balance and optimize the efficiency of medication administration.

Reduce Transmission of COVID-19. During this emergency, it is important to take all precautions to reduce transmission of COVID-19. While we are actively working to increase infection control practices and maximize physical distancing, as health care professionals, we must continue to provide care for our residents as well as ensure that they are receiving the medications they need. 

Reducing the frequency of medication administration is one additional way to help reduce direct physical contact and potentially reduce transmission of COVID-19. 

Here are some tips for evaluating potential areas of opportunity to impact frequency of medication administration:

Ready to save money? New PACE pharmacy services may not get your attention, but the ways they can lower your costs will. From the way meds are filled and delivered to technology and data solutions, new PACE pharmacy services can impact your bottom line.

Meds2Home Streamlines Your PACE Pharmacy Needs

Meds2Home is the future of PACE pharmacy, and the future is here. Keep reading to learn how your center can benefit.

New Pharmacy Services Include Consulting and Testing

Pharmacy consults traditionally respond reactively to address issues a participant is having with medication. Early or proactive pharmacy consults look at a participant’s medications before there is a problem. That’s where Grane Rx’s Medications Insights program powered by YouScript™ comes in. We use a patented technology to help mitigate polypharmacy issues and identify and make medication changes before there is a need to invest in high cost lab tests. Our software enables prescribers to quickly identify more medication interactions and offer alternative medications both within the same medication class and for the same medication. Read more about the benefits of early pharmacy consults related to polypharmacy in the elderly.

Pharmacogenetic testing goes even deeper to assess the effectiveness of particular drugs for particular patients. Consider that 75 percent of all patients have some genetic variations in their medication metabolism enzymes, which may affect how they metabolize, process and react to treatments. Pharmacogenetic testing is beginning to explain the variances that have been seen between patient reaction to particular doses of particular medications.

This tool provides information to improve medication management by enabling providers to select the most appropriate medication at the most appropriate dose for a patient based on how their body will metabolize a medication. This has the potential to reduce the number of medications given to reduce side effects of other medications. That reduction can bring real cost savings as well as positive clinical outcomes.

A great pharmacy partner is always looking for ways to save you money, whether it’s creating a formulary for your organization or exchanging inefficient practices for more streamlined effective ones. Your pharmacy solution may be working, but checking out new pharmacy services may bring cost savings you can’t afford to pass up. 

Anticoagulants are common medications in the PACE environment and are used to prevent blood clots from forming in the body. Popularly known as “blood thinners,” these medications require serious scrutiny from medical personnel when making decisions about care and other medications for PACE participants. Normally, blood clotting is an essential function of the body to protect itself against excessive bleeding in the event of an injury. In other circumstances, though, blood clots can become a dangerous threat to health and well-being if they travel through the blood vessels to the heart, lungs, or brain. Therefore, anticoagulants are typically used in the PACE environment for participants who suffer from:

Also, participants in the PACE environment who have had a synthetic heart valve implanted or received knee or hip replacement are generally on some form of anticoagulant. Let’s take a look at how and why anticoagulants are used within the PACE environment—and examine the risks and benefits.

The Role of Anticoagulants in the PACE Environment

Every year in the United States, approximately 900,000 people suffer a pulmonary embolism or deep vein thrombosis, resulting in 100,000 deaths. At least 25 percent of individuals who suffer a pulmonary embolism die suddenly without any warning symptoms. Men and women who are at a higher risk for blood clots include those who have atherosclerosis, diabetes, heart failure, irregular heart rates, immobility, obesity, and malignancy. Prescribing anticoagulants following an initial blood clot is vital, considering 30 percent of those who have a blood clot will have another clotting incident within ten years. Half of blood clots occur during or soon after surgery or a hospital stay. Many within the PACE environment display one or more risk factors for forming blood clots. [Tweet “#Anticoagulant use is common in the #PACE environment, but it requires some careful considerations.”]

Anticoagulants in the PACE Environment

Although anticoagulants are commonly called “blood thinners,” they do not make the blood thinner. They serve a dual purpose of:

Anticoagulants defeat blood clots by reducing the blood’s ability to clot, either by inhibiting vitamin K or by stopping other clotting factors from operating.

While this is good news for eliminating clots or reducing their risk, it raises the risk of prolonged bleeding should a person suffer a cut or nick. This is the primary risk and unwanted side effect of anticoagulants.

Anticoagulants are available as either oral or injectable products. Oral medications are generally used for ongoing prophylaxis in the outpatient setting for easier administration.

A benefit of the new oral therapies in the PACE environment is they do not require routine blood monitoring. Injectable products are typically used more at the beginning of therapy, especially when treating an existing clot.

In recent years, several new oral anticoagulation therapies were approved by the FDA—Eliquis® (apixaban), Pradaxa® (dabigatran), Savaysa® (edoxaban), and Xarelto® (rivaroxaban). These anticoagulants defeat blood clots by inhibiting thrombin (Pradaxa) or factor Xa (Eliquis, Savaysa, and Xarelto).

The above medications are short-acting compared to warfarin (Coumadin®). So, if therapy is missed, interrupted, or irregular, there is a risk for breakthrough strokes.

If regular therapy is a concern, these medications may not be the best option within the PACE environment, and warfarin may be the likely anticoagulant of choice.

As mentioned above, while the desired results of anticoagulants are admirable and desired, the most undesirable effect is an increased risk for prolonged bleeding. While administering vitamin K has a reversing effect for the anticoagulant warfarin, others do not have reversing agents.

An interest certainly exists for developing reversal agents for the other mentioned products, but none are available at this time.

When switching to warfarin from Eliquis, Pradaxa, Savysa, or Xarelto, those in the PACE environment will need to continue current anticoagulant therapy in addition to the warfarin until their INR reaches effective levels. This should take about five days.

With Pradaxa, medical professionals recommend stopping therapy after one to two days on warfarin, so long as renal function is normal. If renal function is impaired, wait until day three to stop administering Pradaxa.

PACE participants have unique and specialized needs. Our Grane Rx team of geriatric-specialized pharmacists understands those challenges and works with PACE centers to overcome them. Partner with us today by calling (412) 449-0504.

flu complications among elderly adults cost a staggering $56 billion. Adults who are 65 and older, including PACE participants, are at a higher risk for encountering complications from the flu virus. This is especially true for those with underlying health conditions. The enormous clinical and economic burden from influenza outbreaks has long motivated vaccine manufacturers to invest in developing an improved annual flu vaccine for senior adults. One vaccine, licensed in the United States in 2009, and known as the trivalent inactivated influenza vaccine Fluzone High-Dose, has demonstrated better efficacy and effectiveness compared with standard-dose influenza vaccines in older adults. [Tweet “Is the high-dose #fluvaccine really better for #PACE participants?”]

Is the High-dose Flu Vaccine Effective for PACE Participants?

A randomized, controlled FIM12 study proved the overall effectiveness of the high-dose flu vaccine. In this study, 31,989 participants were enrolled from 126 research centers in Canada and the United States.
According to this study, among those 65 years or older, Fluzone High-Dose provided better protection and induced significantly higher antibody responses against laboratory-confirmed influenza than Fluzone Standard-Dose.

Investigators from the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, and the U.S. Food and Drug Administration reported that the high-dose vaccine was 22 percent more effective than the standard-dose vaccine for the prevention of probable influenza.

It was also 22 percent more effective in preventing flu-related emergency room visits and hospital admissions, both important factors among PACE participants.

What About the Cost of the High-dose Flu Vaccine for PACE Participants?

A critical health question for senior adults—and PACE centers—is the cost-effectiveness of the high-dose flu vaccine. Could the vaccine reduce the significant economic burden of flu outbreaks in adults older than age 65?
In one study of cost analysis, the high-dose trivalent inactivated flu vaccine is a cost-saving alternative to the standard-dose vaccine. Moreover, the additional cost of administering a high-dose instead of a standard-dose vaccine produced a staggering 587 percent financial benefit to the healthcare system.

The majority of those savings came through reductions in cardiorespiratory hospital admissions related to the flu. The study results indicate that the high-dose vaccine saved costs over the analyzed two-year period, and therefore showed better cost-effectiveness than most other strategies used.

Although initial costs for the high-dose flu vaccine are higher than the standard-dose vaccine, results of cost analyses favor the high-dose vaccine, mainly because of the reduction of hospital admissions.

PACE providers must focus on patient-centered care while considering the well-being of the participant and the cost savings when recommending immunizations during flu season.

Seniors, including PACE participants, have unique and specialized needs. Our Grane Rx team of geriatric-specialized pharmacists understands those challenges and works with PACE centers to overcome them. Partner with us today by calling (412) 449-0504.]]>