Maintaining healthy blood sugar levels among Skilled Nursing Facility residents is always a challenge. Long-term care pharmacy providers must consider a number of factors that can affect blood glucose management.
Irregular nutritional intake, physiological changes, impaired renal function, or even variable physical activity can all cause significant swings in blood glucose levels. Trying to nail down the exact cause for the changes can be a daunting task.
Some commonly overlooked factors that can contribute to blood glucose level variations include the resident’s skin condition, the technique used for injecting insulin, and how the injection site is treated.
Read on for a look at some best practices for administering insulin injections recommended by long-term care pharmacy providers.
Long-term Care Pharmacy Injection Basics
When administering injectables of any kind to SNF residents, including insulin, always follow these basic precautions:
- Wash or disinfect hands before handling any injection materials.
- Clean and disinfect the injection site; be sure any alcohol is completely evaporated before giving injections.
- Insert needle at a 90 degree angle—or perpendicular to the surface of the skin.
- Do not give injections through clothing.
- Very thin residents may require injecting into a skin fold.
- Avoid giving injections into muscle tissue.
- Immediately dispose of all used materials.
Long-term Care Pharmacy Injection Best Practices
Be aware of the unique needs of each resident and his or her medication schedule.
The following best practices recommended by post-acute care pharmacy providers will help you administer insulin injections with more sensitivity and less pain.
Rotate Injection Sites
Rotating injection sites will promote proper absorption and avoid the development of lipohypertrophy. Areas with lipohypertrophy can cause random and unpredictable blood sugar level changes.
- Each injection should be given at least two inches from a previous injection, according to a planned and documented rotation schedule.
- Divide injection sites into quadrants or halves, and rotate one section a week in the same direction.
- Avoid aggravating lipohypertrophy by not injecting into areas that are firm, lumpy, or enlarged.
- For mealtime doses, choose the abdomen or upper arms for faster absorption.
- For a bedtime dose, choose the upper thigh or buttocks for slower absorption that lasts throughout the night.
Repeated injections into areas with lipohypertrophy or lipodystrophy can significantly slow the absorption of insulin. The resulting elevated blood glucose levels may then be attributed to another, erroneous cause instead of a flawed injection administration technique.
Use the Correct Needle
Studies recorded in the Mayo Clinic Proceedings demonstrate that residents of any size benefit more from injections using a 4mm long needle. The 4-mm needle length for both injections and infusions works to get through the skin and access the subcutaneous fat where insulin needs to be delivered, even in obese persons.
Use the Correct Injection Technique
Injecting insulin at the optimum depth is vital for proper absorption and maintaining healthy blood glucose levels. Long-term care pharmacy providers recommend injecting insulin in the subcutaneous fat, or the layer of fat beneath the skin.
Injecting too deep can penetrate a muscle, which is painful. Also, the muscle tissue absorbs insulin faster so that the dosage doesn’t last for the necessary amount of time.
If the injection isn’t deep enough, the insulin goes into the skin, which also affects the rate of absorption and effectiveness.
A proper injection technique follows these protocols:
- Pinch a few inches of skin between a thumb and two fingers, pulling it gently away from the muscle.
- Insert the needle into the skin fold at a 90-degree angle.
- Hold the pinched skin so the needle doesn’t go into the muscle.
- Press the plunger to inject the insulin.
- Release the grip on the skin fold.
- Remove the needle from the skin.
Our Grane Rx team works with your team to help ensure optimal care for residents. Learn more about our long-term care pharmacy services and how we can partner with you by calling (866) 824-MEDS (6337).
Jennifer Devinney is the Chief Clinical Officer for Grane Rx. In this role, she works with clinical pharmacists and nurses in conjunction with facility staff to develop and oversee clinical initiatives. Additionally, she is the clinical EHR integration specialist.
Categories: Clinical Care Advantage