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Insulin injection errors may have exposed veterans to viruses

The pen needles are designed to be for one patient. The needle device is clean every time, but it's risky to keep using the pen device in multiple people.

They really have no excuse, insulin comes in several dosage forms and there is certainly insulin that can be drawn up in a sterile vial to be given to each patient when they need it. The pharmacists, physicians, and nurses that allowed this should all be held accountable.
 
In the nurses' defence, the article suggests the new technology (pens) were introduced without training in how to use them properly.
 
poweRob said:
That is horrendous. However, I will say that while that was the Buffalo, NY Va. The service I got at the Carl T Hayden VA in Phoenix was absolutely exemplary.
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What kind of care did you get there? The OKC facility has some good doctors, some bad. Same in Shreveport, La. But even the good doctors are hampered by the system.

Only med approved for your condition? Too bad, have to go through trials of other meds first before you get that one.

Got a torn knee? Yes, even with an x-ray showing a torn meniscus (from another facility), have to go through physical therapy first, before you can see orthopedics. Don't already have the x-ray/MRI, have to go through physical therapy first.

Suffer from Sinusitis or other nasal problems? First, get the doctor to actually listen that you have a problem. Next, 3 months on nasal flush (available at Walmart, not free from the pharmacy), anti-histamines, and nasal spray. Didn't work? Next, 3 more months with nasal spray, anti-histamines, nasal flush and they add an anti-biotic. Still didn't work, ok, now they can do a cat scan of your sinuses and if it shows reason to, then you can be referred to ENT.

On the plus side, if they suspect arthritis, you can get an x-ray in a month or two.

It has taken me 5 years to actually get a doctor that both understands English well enough to communicate with and will listen. Most just run their checklist of certain items, tell you to quit smoking and never listen beyond that. Why the Shreveport facility actually hired a psychiatrist that doesn't even communicate well in English is beyond me. You would think that that is one field where the ability to communicate would be required. The Indian, Pakistani and Iraqi doctors weren't bad (ok, 1 was, not the rest), they were just hampered by their ability to communicate.

For Basic health needs and a few military specialty requirements, the VAs I have dealt with are pretty decent. But need care beyond the normal, and they really don't hold up.

Gee, and some people want the government to run everyones healthcare. I Just don't get it, apparently they have never dealt with government run systems before.
 
My uncle got great care from an Ann Arbor VA hospital for about 15 years. Then all of a sudden quality dropped. He was over-prescribed blood thinners, then recommended for surgery which nearly killed him. He was prescribed medication for arthritis that reacted badly with a medication he was already taking for a degenerative spine condition, nearly killed him. He nearly went septic after a "routine" procedure introduced a pretty serious staph infection into his system. Etc., etc., etc.

Personally, I think our vets should be getting the absolute best healthcare out there EVERY single time they visit a doctor. I don't know many vets who do, though.
 
digsbe said:
The pen needles are designed to be for one patient. The needle device is clean every time, but it's risky to keep using the pen device in multiple people.

They really have no excuse, insulin comes in several dosage forms and there is certainly insulin that can be drawn up in a sterile vial to be given to each patient when they need it. The pharmacists, physicians, and nurses that allowed this should all be held accountable.
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I have experience with the pen delivery system, and it beats the old syringe delivery system by miles.

The ability to read the old syringes requires a magnifying glass, 20/20 vision and a micrometer. :wink The pen system has more flexibility in dosages (half units) and a hell of a lot easier to set the dose than a syringe does.

There is always the tiniest chance of backwash of insulin in any needle related delivery device, no matter if you change the needle or not, since the function on pressure and suction. The pen needles are disposable, but puncture a membrane to draw the insulin through to the needle.

I really hope for these Veteran's sakes that nothing was passed along.
 
I live in an overlap area. Generally one is mostly praised and the other is mostly criticized, but there are enough people who are critical of the overall better one and others that prefer the one that gets the more criticism to make me say it largely becomes subjective.

As for the reuse of the pen, hopefully nobody gets ill. It seems like it is more a theoretically possible danger than a confirmed one at this point.
 
GottaGo said:
I have experience with the pen delivery system, and it beats the old syringe delivery system by miles.

The ability to read the old syringes requires a magnifying glass, 20/20 vision and a micrometer. :wink The pen system has more flexibility in dosages (half units) and a hell of a lot easier to set the dose than a syringe does.

There is always the tiniest chance of backwash of insulin in any needle related delivery device, no matter if you change the needle or not, since the function on pressure and suction. The pen needles are disposable, but puncture a membrane to draw the insulin through to the needle.

I really hope for these Veteran's sakes that nothing was passed along.
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There isn't going to be a risk of blood backwash or contamination with other body fluids if insulin is drawn up from a sterile vial using a sterile needle that is supposed to be disposed of after 1 use. The older syringes are not too difficult to read. Regardless, even if they are difficult that doesn't justify using an easier pen needle dosing system in multiple people. It's completely unethical to try and take an easy way out and put patients at risk because drawing up an insulin amount may be difficult.


Manc Skipper said:
In the nurses' defence, the article suggests the new technology (pens) were introduced without training in how to use them properly.
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To tell you the truth that's a piss poor defense. If a healthcare professional doesn't know how to do something or is not trained on something they need to defer that to someone else or become trained on how to use a new medication or doing a new procedure. If a physician doesn't know how to properly treat a disease they are supposed to send their patient to a specialist that does. If a surgeon doesn't know a procedure they are supposed to allow another surgeon to do it. If a pharmacist doesn't know much about a certain drug it's their duty to educate themselves before dispensing it and doing the clinical review to see if it is safe to be given to their patients. If a nurse doesn't know how to administer a drug or hasn't been trained on a certain medication they need to seek training. Not being trained on how to use a pen needle or knowing that they are not to be used in multiple patients is not a valid defense for the nurses that allowed this to happen.
 
digsbe said:
There isn't going to be a risk of blood backwash or contamination with other body fluids if insulin is drawn up from a sterile vial using a sterile needle that is supposed to be disposed of after 1 use. The older syringes are not too difficult to read. Regardless, even if they are difficult that doesn't justify using an easier pen needle dosing system in multiple people. It's completely unethical to try and take an easy way out and put patients at risk because drawing up an insulin amount may be difficult.




To tell you the truth that's a piss poor defense. If a healthcare professional doesn't know how to do something or is not trained on something they need to defer that to someone else or become trained on how to use a new medication or doing a new procedure. If a physician doesn't know how to properly treat a disease they are supposed to send their patient to a specialist that does. If a surgeon doesn't know a procedure they are supposed to allow another surgeon to do it. If a pharmacist doesn't know much about a certain drug it's their duty to educate themselves before dispensing it and doing the clinical review to see if it is safe to be given to their patients. If a nurse doesn't know how to administer a drug or hasn't been trained on a certain medication they need to seek training. Not being trained on how to use a pen needle or knowing that they are not to be used in multiple patients is not a valid defense for the nurses that allowed this to happen.
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I'm not saying it's a good defence, there were many failures at many levels. The pharmacists just issued them without checking that the nurses knew how they worked. It's really a simple management health and safety issue flub. You can't introduce new equipment to the workplace without training the staff how to use it.
 
digsbe said:
There isn't going to be a risk of blood backwash or contamination with other body fluids if insulin is drawn up from a sterile vial using a sterile needle that is supposed to be disposed of after 1 use. The older syringes are not too difficult to read. Regardless, even if they are difficult that doesn't justify using an easier pen needle dosing system in multiple people. It's completely unethical to try and take an easy way out and put patients at risk because drawing up an insulin amount may be difficult.

.
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I wasn't defending the multiple use. Quite the opposite.

Maybe I didn't explain myself well regarding the pen delivery system.

The needle is a cap, which puntures a membrane in the cartridge of insulin (which contains more than one dose), and delivers the insulin directly from the cartridge subcuteously. You then pull it out of the skin, and remove the needle. the plunger that measures the dose is at the other end of the cartridge, and works on a pressure/suction basis.

Even if you dispose of the pen needle, the way the cartridge works could very easily suck in contamination. There are warnings about contamination in with the cartridges. It should NEVER be used for more than one person.

One would have thought, even without training, those in the healthcare field would have figured that out.
 
GottaGo said:
I wasn't defending the multiple use. Quite the opposite.

Maybe I didn't explain myself well regarding the pen delivery system.

The needle is a cap, which puntures a membrane in the cartridge of insulin (which contains more than one dose), and delivers the insulin directly from the cartridge subcuteously. You then pull it out of the skin, and remove the needle. the plunger that measures the dose is at the other end of the cartridge, and works on a pressure/suction basis.

Even if you dispose of the pen needle, the way the cartridge works could very easily suck in contamination. There are warnings about contamination in with the cartridges. It should NEVER be used for more than one person.

One would have thought, even without training, those in the healthcare field would have figured that out.
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I apologize, I head read your post wrong.

I have experience with the pen needles too (they are commonly dispensed). I would also imagine that people in healthcare would recognize that they are for individual use and not for multiple people. It's common sense with pretty much any medication that is injected.
 
GottaGo said:
I have experience with the pen delivery system, and it beats the old syringe delivery system by miles.
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I don't like the pen, the needle is too short and the insulin burns while being injected. I very quickly went back to vial and syringe. If it doesn't burn for you, then I can see how the pen would be preferable.
 
Another sad part of it all is that Vietnam Vets who were exposed to Agent Orange have been determined to exhibit a higher level of Diabetes 2. If you were exposed to Agent Orange - and that is determined by knowing where you were in-country (and exposure happened in all IV Corps) you are automatically eligible for VA related medical care.

Of course people who have been, are or will be in the **** in Middle East already have their own lingering physical issues, and will, due to the toxic mix of the war zone. It was only last year, I think, that ME War Vets got the VA to recognize Gulf War Syndrome and agree to provide medical services. There's even more ME War Vets are fighting to have the VA recognize.

So far I've been fortunate. The VA has been generally good to me. I will say that I prefer the VA Hearing Clinic in Tucson to the one at Carl Hayden in Phoenix. I'm moving my service to Tucson as soon as I hear back from them regarding an appointment.

War is the gift that just keeps on giving.
 
DVSentinel said:
What kind of care did you get there? The OKC facility has some good doctors, some bad. Same in Shreveport, La. But even the good doctors are hampered by the system.

Only med approved for your condition? Too bad, have to go through trials of other meds first before you get that one.

Got a torn knee? Yes, even with an x-ray showing a torn meniscus (from another facility), have to go through physical therapy first, before you can see orthopedics. Don't already have the x-ray/MRI, have to go through physical therapy first.

Suffer from Sinusitis or other nasal problems? First, get the doctor to actually listen that you have a problem. Next, 3 months on nasal flush (available at Walmart, not free from the pharmacy), anti-histamines, and nasal spray. Didn't work? Next, 3 more months with nasal spray, anti-histamines, nasal flush and they add an anti-biotic. Still didn't work, ok, now they can do a cat scan of your sinuses and if it shows reason to, then you can be referred to ENT.

On the plus side, if they suspect arthritis, you can get an x-ray in a month or two.

It has taken me 5 years to actually get a doctor that both understands English well enough to communicate with and will listen. Most just run their checklist of certain items, tell you to quit smoking and never listen beyond that. Why the Shreveport facility actually hired a psychiatrist that doesn't even communicate well in English is beyond me. You would think that that is one field where the ability to communicate would be required. The Indian, Pakistani and Iraqi doctors weren't bad (ok, 1 was, not the rest), they were just hampered by their ability to communicate.

For Basic health needs and a few military specialty requirements, the VAs I have dealt with are pretty decent. But need care beyond the normal, and they really don't hold up.

Gee, and some people want the government to run everyones healthcare. I Just don't get it, apparently they have never dealt with government run systems before.
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I had a serious problem with kidney stones for a spell. I had my first bout at 21 but then not again until my mid to late 30's. I passed all of them but one. I had to have surgery to blast it into smaller pieces so that it would pass. That surgery was done by the VA. The unfortunate side of the experience was that the VA had only one stone shattering machine for a region and it travelled so I had to wait a month before the machine was back in Phoenix.

Sooooo.... they had to surgically put a stint inside me for that monthlong wait. I was nervous as hell but I don't remember a damn thing and the surgery went off without a hitch but it effected me psychologically. I kind of turned into an agoraphobe and really REALLY didn't want to ever leave the house and if I did I was kind of a wreck.

Then they had a surgery that they knocked me out and laid me on an operating table that had a hole in the middle and that hole had a rubber bladder in it full of water. They put your effected kidney in the water and shoot the sonic blast through the water aimed at the stone and turn it to a frequency that shatters the stone... voila. It's done. They knock you out because you can't move a single iota while this is happening. That surgery was great and went off without a hitch.

The final thing was they had to remove the stint which is a local anesthetic and you are awake. That went off without a hitch.

Sorry for the details if it is too much.

All of my doctor visits for this and just check ups I really liked. They have different doctor sections and they assign you to one then within that section you get a doctor that is your regular doctor. They check you out and if you need anything at all like drugs or x-rays or what-have-you, you just stroll down the hall and it's there. Drugs are EXTREMELY cheap by comparison.

I don't know. Other than my stone epsiodes I really don't use doctors and hospitals or whatever much at all but my experiences have been really good. From what I understand, having McCain as a Senator in the state had some help in establishing the Carl T Hayden center as a good one. I've not experience with other VA's TBH.
 
Scrabaholic said:
I don't like the pen, the needle is too short and the insulin burns while being injected. I very quickly went back to vial and syringe. If it doesn't burn for you, then I can see how the pen would be preferable.
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Just a heads up, you can purchase the pen needles in different lengths and diameters that may suit you better. (Not sure if you were aware of that).
 
Scrabaholic said:
I don't like the pen, the needle is too short and the insulin burns while being injected. I very quickly went back to vial and syringe. If it doesn't burn for you, then I can see how the pen would be preferable.
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I didn't get much burn. I kept my current pen at room teperature, which I'm told will help with that. There are longer pen needles available if you need them.

I now use a pump. Expensive, but it has done wonders for my A1c.
 
Manc Skipper said:
In the nurses' defence, the article suggests the new technology (pens) were introduced without training in how to use them properly.
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That's what I was thinking. It's a case of murphy's law, not related to poor veteran care, in a malicious way.
 
GottaGo said:
I didn't get much burn. I kept my current pen at room teperature, which I'm told will help with that. There are longer pen needles available if you need them.

I now use a pump. Expensive, but it has done wonders for my A1c.
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Got a link for that?
 
I bet if it happened in a civilian hospital, you would have never heard about it. The VA has a system in place for catching and reporting errors. The civilian sector practices much more efficient damage control. And there is no excuse for a nurse to perform a procedure they were not trained on. On one hand, very dissapointing a VA employee did it, but a positive that it was caught and reported in the long run.
 
digsbe said:
I have experience with the pen needles too (they are commonly dispensed). I would also imagine that people in healthcare would recognize that they are for individual use and not for multiple people. It's common sense with pretty much any medication that is injected.
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I agree with you completely, but also find it odd that the pens hadn't come from the pharmacy with individual patient labels. Where I work (and in other hospitals where I have worked in the past), pharmacies don't dispense medications for individual patients without labeling them specifically.
 
mak2 said:
I bet if it happened in a civilian hospital, you would have never heard about it. The VA has a system in place for catching and reporting errors. The civilian sector practices much more efficient damage control. And there is no excuse for a nurse to perform a procedure they were not trained on. On one hand, very dissapointing a VA employee did it, but a positive that it was caught and reported in the long run.
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Good point,I agree. The, so called, "patient's advocate" in civilian hospitals do nothing but "cover the asses" of the people who screw up in the hospital. It's a waste of breath to talk to them. They are paid by the hospitals.
 
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Now the tea partiers are complaining cause the goberment isn't taking care of them well enough.

Get a private doctor, and stop whining.
 
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