Safe Insulin Administration When Barcode Scanner Fails

Scenario

The hospital’s barcode system is temporarily offline. You are responsible for administering Humalog 6 units subcutaneously to a patient before lunch.
Without barcode verification, you must rely solely on manual safety checks to prevent medication error.

Question: How will you ensure the insulin is administered safely and accurately?

Best Practice Answer

1. Manual Patient and Medication Verification:
   Begin by confirming two patient identifiers — name and MRN — directly with the patient and their wristband. Cross-check this with the medication administration record (MAR).

   • Verify the five rights: right patient, right drug, right dose, right route, and right time.
   • Confirm the indication: this insulin is for pre-meal blood sugar control.

2. Independent Double-Check (High-Alert Medication):
   Insulin and heparin require a second RN verification even when technology is unavailable.

   • The verifying RN reviews the vial, label, and drawn syringe independently.
   • Both nurses confirm aloud: “Humalog, rapid-acting, 6 units, subcutaneous, before lunch.”

3. Inspect and Prepare:

   • Use only a U-100 insulin syringe (never a tuberculin syringe).
   • Check expiration date, clarity, and correct type (Humalog ≠ Lantus).
   • Draw exactly 6 units; ensure no air bubbles remain.
   • Choose an appropriate injection site (abdomen preferred), avoiding lipohypertrophy areas.

4. Administer Safely:

   • Clean site with alcohol and allow to dry.
   • Inject at 90° angle using pinch-up technique if needed.
   • Do not aspirate; insulin is given into subcutaneous tissue.
   • Rotate site to prevent tissue changes.

5. Post-Administration Actions:

   • Confirm the patient’s meal tray is present and encourage eating promptly to prevent hypoglycemia.
   • Recheck blood glucose 15–30 minutes post-dose if protocol indicates.
   • Observe for signs of hypoglycemia (sweating, confusion, tremor).

6. Documentation and Communication:

   • Record dose, site, and time on the paper MAR or downtime form.
   • Once the system is restored, reconcile documentation in the EMR.
   • If any near-miss occurs, complete a safety event report per just culture policy.

Real-World Application

This situation tests your ability to maintain patient safety during downtime or system failure — a reality in every hospital.
Hospitals expect nurses to rely on manual verification, double-checks, and policy knowledge when automation fails.

In real practice, this applies during:

• Network outages and barcode downtime drills
• Emergency response units and temporary field hospitals
• Float-pool assignments where devices are limited

Interview Insight

Managers look for:

• Rigid adherence to verification policies
• Recognition that insulin is high-alert under ISMP
• Calm, systematic approach despite technical failure

Tip: Always mention “independent double-check and downtime documentation.” It signals maturity and familiarity with Joint Commission standards.