A nurse is providing discharge instructions to a client who is to self-administer insulin at home

1. Gelder C. Best practice injection technique for children and young people with diabetes. Nurs Child Young People 2014;26:32–36 [PubMed] [Google Scholar]

2. Alabraba V, Floyd E, Morgan C, Kelly C, Wallymahmed M. “My diabetes, my insulin”: self-administration of insulin in hospital. J Diabetes Nurs 2014;18:296–299 [Google Scholar]

3. Lamont T, Cousins D, Hillson R, Bischler A, Terblanche M. Safer administration of insulin: summary of a safety report from the National Patient Safety Agency. BMJ 2010;341:c5269. [PubMed] [Google Scholar]

4. Sharpe L. Improving safety of insulin administration: a pilot audit of hospital staff knowledge. J Diabetes Nurs 2012;16:8–16 [Google Scholar]

5. Ogston-Tuck S. Subcutaneous injection technique: an evidence-based approach. Nurs Stand 2014;29:53–58 [PubMed] [Google Scholar]

6. Patton S, Eder S, Schwab J, Sisson C. Survey of insulin site rotation in youth with type 1 diabetes mellitus. J Pediatr Health Care 2010;24:365–371 [PMC free article] [PubMed] [Google Scholar]

7. Dolinar R. The importance of good insulin injection practices in diabetes management. US Endocrinol 2009;5:49–52 [Google Scholar]

8. Vardar B, Kizilci S. Incidence of lipohypertrophy in diabetic patients and a study of influencing factors. Diabetes Res Clin Pract 2007;77:231–236 [PubMed] [Google Scholar]

9. Davis E, Christensen C, Nystrom K, Foral P, Destache C. Patient satisfaction and costs associated with insulin administered by pen device or syringe during hospitalization. Am J Health Syst Pharm 2008;15;65:1347–1357 [PubMed] [Google Scholar]

10. American Diabetes Association Insulin administration. Diabetes Care 2003;26(Suppl. 1): S121–S124 [PubMed] [Google Scholar]

11. Shogbon A, Ngo D, Jacob B, Kimble L, Ryan G. Nurses’ perceptions and satisfaction with the use of insulin pen devices compared with insulin vial and syringes in an inpatient setting. Diabetes Technol Ther 2014;16:742–746 [PubMed] [Google Scholar]

12. Saltiel-Berzin R, Cypress M, Gibney M. Translating the research in insulin injection technique: Implication for practice. Diabetes Educ 2012;38:635–643 [PubMed] [Google Scholar]

13. Wood L, Wilbourne J, Kyne-Grzebalski D. Administration of insulin by injection. Practical Diabetes Int 2002;19 (Suppl. 2-1):S1–S4 [Google Scholar]

14. Rosindale S. Advanced preparation of insulin syringes for adult patients to administer at home: RCN guidance for nurses. 2nd ed. London, Royal College of Nursing, 2015. Available from https://www2.rcn.org.uk/__data/assets/pdf_file/0010/619804/RCNguide_insulin_syringes_WEB.pdf. Accessed 14 September 2016 [Google Scholar]

15. Trimble L, Meneilly G. Optimizing insulin absorption and insulin injection technique in older adults. Diabetes Care 2014;37:e127–e128 [PubMed] [Google Scholar]

16. De Coninck C, Frid A, Gaspar R. Results and analysis of the 2008–2009 insulin injection technique questionnaire survey. J Diabetes 2010;2:168–179 [PubMed] [Google Scholar]

17. Zhou L, Fan Y, Lu X. Feasibility study of vertical subcutaneous injection of insulin with an insulin pen injector in diabetic patients with normal body mass index. J Int Med Res 2010;38:669–673 [PubMed] [Google Scholar]

18. Yakushiji F, Fujita H, Terayama Y. The best insulin injection pen device for caregivers: results of injection trials using five insulin injection devices. Diabetes Technol Ther 2010;12:143–148 [PubMed] [Google Scholar]

19. Partanen T, Rissanen A. Insulin injection practices. Pract Diabetes Int 2000;17:252–254 [Google Scholar]

20. Frid A, Hirsch L, Gaspar R. New injection recommendations for patients with diabetes. Diabetes Metab 2010;36 (Suppl. 2):S3–S18 [PubMed] [Google Scholar]

21. Dougherty L, Lister S. The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 8th ed. Oxford, England, Blackwell Publishing, 2011 [Google Scholar]

22. Becker H, Blanche G. The analysis of qualitative field data. In Human Organization Research. Adams RA, Preiss JJ, Eds. Homewood Ill., Dorsey Press, 1960, p. 267–289 [Google Scholar]

23. Glaser B. The constant comparative method of qualitative research. Soc Probl 1965;12:431–445 [Google Scholar]

24. Moran B, Arnott S. Guideline for the administration of insulin by nursing staff. Diabetes Managed Clinical Networks and National Health Service Lanarkshire, 2014. Available from http://www.nhslanarkshire.org.uk/Services/Diabetes/Diabetes%20Clinical%20Guidelines/Documents/Guideline%20for%20the%20Administration%20of%20Insulin%20by%20Nursing%20Staff%20final%20May14.pdf. Accessed 14 September 2016 [Google Scholar]

25. American Diabetes Association : Insulin administration (Position Statement). Diabetes Care 2002(Suppl. 1);25:S112–S115 [Google Scholar]

26. Shank M. Trouble with bubbles. Am J Nurs 1999;99:14–16 [PubMed] [Google Scholar]

27. Heinemann L. Insulin absorption from lipodystrophic areas: a (neglected) source of trouble for insulin therapy? Diabetes Sci Technol 2010;4:750–753 [PMC free article] [PubMed] [Google Scholar]

28. Koivisto V, Felig P. Is skin preparation necessary before insulin injection? Lancet 1978;311:1072–1073 [PubMed] [Google Scholar]

29. World Health Organization WHO guidelines best practice for injections and related procedures toolkit, 2010. Available from http://apps.who.int/iris/bitstream/10665/44298/1/9789241599252_eng.pdf. Accessed 14 September 2016

30. Hansen B, Kirketerp G, Ehlers G, Nordentoft E, Hansen G. Evidence-based clinical guidelines for injection of insulin for adults with diabetes mellitus. Copenhagen, Denmark, Danish Nurses Organization, 2007 [Google Scholar]

31. Hofman P, Derraik J, Pinto T. Defining the ideal injection techniques when using 5-mm needles in children and adults. Diabetes Care 2010;33:1940–1944 [PMC free article] [PubMed] [Google Scholar]

32. Nicol M, Bavin C, Bedford-Turner S, Cronin P, Rawlings-Anderson K. Essential Nursing Skills. 2nd ed. Edinburgh, Scotland, Mosby, 2004 [Google Scholar]

33. Pratt R, Pellowe C, Wilson J, et al.. epic2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007;65(Suppl. I):S1–S4 [PMC free article] [PubMed] [Google Scholar]

34. Hicks D, Kirkland F, Pledger J, Down S. The first UK injection technique recommendations. 2nd ed. London, 2011. Available from http://fit4diabetes.com/files/2613/3102/3031/FIT_Recommendations_Document.pdf. Accessed 14 September 2016 [Google Scholar]

35. Strauss K, De Gols H, Hannet I, Partanen T, Frid A. A pan-European epidemiologic study of injectable therapy injection technique in patients with diabetes. Pract Diabetes Int 2002;19:71–76 [Google Scholar]

36. Mushtaq M. Study of insulin injection technique amongst the nursing staff. Pak J Med Sci 2006;22:310–312 [Google Scholar]

37. Bajwa S, Kalra S, Baruah M, Bajwa S. An acute need for awareness of insulin injection guidelines in operative and intensive care units. Anesth Essays Res 2013;7:1–3 [PMC free article] [PubMed] [Google Scholar]


Page 2

κ Statistic for Each Pair of Data Collectors’ Observations

ObservationE–GG–FE–F
Clean, washed hands0.8140.8210.814
Use of gloves0.8220.8110.822
Flacon antisepsis0.9040.8180.832
Air bubbles0.7940.8010.801
Location check0.8200.8170.810
Use of antiseptic solution0.8320.8380.842
Angle of needle1.000.8520.858
Post-injection care0.9120.8670.872
Mean0.8620.8280.831