Drug related problems and intervention in the use of insulin injections among diabetic inpatients at NueaKlong hospital, Krabi Province

Abstract

This descriptive study aimed to identify drug-related problems associated with insulin injection use among diabetic patients admitted to the inpatient department of NueaKhlong Hospital, Krabi Province, and to propose appropriate solutions to improve insulin administration practices. Data were collected using a general information record form and a questionnaire on insulin pen use. The data were analyzed using frequency distribution, percentage, mean, and content analysis for open-ended responses. The study population consisted of 50 diabetic inpatients using insulin injections who met the inclusion criteria during April–August 2025. The study period lasted for six months. The results revealed that most insulin-using diabetic patients were female, with the majority aged between 66–75 years. Most participants had primary education, followed by those who were illiterate but could read, together accounting for 80%. A total of 84% of patients performed insulin injection steps incorrectly, while only 16% performed all steps correctly. The most frequently incorrect step in preparing the insulin pen was handwashing or hand cleaning before preparing the injection, with only 52% performing it correctly. In the injection procedure, the least correctly performed step (62%) was mixing the suspension insulin by rolling the pen horizontally ten times, followed by dose adjustment according to the physician’s order (74%). Regarding storage and basic knowledge of insulin injection, the most incorrectly performed step (78% correct) involved storing unused insulin in the middle compartment of the refrigerator rather than the freezer, vegetable compartment, or door. However, a critical step—pressing and holding the injection button until the full dose was delivered—was performed incorrectly by only one patient, who consequently developed severe hyperglycemia leading to hyperosmolar hyperglycemic state (HHS), highlighting the importance of this step in patient education. The findings serve as a foundation for developing pharmaceutical care guidelines for insulin use among diabetic patients in NueaKhlong Hospital. Since this study was conducted in a single hospital, the context may differ from other healthcare settings. Future studies should explore insulin injection-related problems in other contexts to develop more specific and effective pharmaceutical care interventions.