Page 65 - Demo

64 CPD ACTIVITY FROM PAGE 63 Needle disposal Pharmacists play a vital role in educating patients on the safe disposal of sharps, which include pen needles, insulin syringes and lancets. Fifty-five per cent of patients surveyed in the 2014-15 ITQ admitted to throwing their insulin needles directly into the rubbish after use.3 Appropriate needle disposal helps reduce the risk of needle stick injury and transmission of blood-borne diseases (HIV, Hepatitis) to household members, carers, healthcare professionals and the community. Pharmacists can provide sharps bins to patients along with advice on how to dispose once full. It’s appropriate for patients to dispose of their personal sharps collector into a larger sharps disposal facility (such as those at public health centres, or larger bins provided to pharmacies in pharmacy needle and syringe programs – in certain states and territories). Disposal programs may have variations between the states and territories and local councils.1 Pharmacists should be aware of their local guidelines for disposal of sharps and be prepared to provide education on the importance of appropriate sharps disposal to patients. Psychology of insulin treatment Insulin injection anxiety can affect patients with type 1 and type 2 diabetes.14 Patients with injection anxiety may avoid administering doses of insulin and have concerns about having to inject more frequently.14 For patients with type 1 diabetes, insulin is started at the time of diagnosis, which can cause anxiety.1 Healthcare professionals should ensure that patients have adequate support, are shown empathy and provided with ongoing education on injection techniques.1 For patients with type 2 diabetes, there can be feelings of failure due to their previous efforts of oral therapy and lifestyle adjustments being inadequate to manage their condition. Insulin use in a patient with type 2 diabetes can sometimes be viewed by the patient as a symbol of the disease worsening.15 Patients should be reminded that insulin is an effective therapy and forms part of the normal progression for the essential treatment of their chronic condition. Scope and limitations of the pharmacist It’s important that pharmacists proactively Table 1: Angle of injection (degrees) and use of a skin fold for insulin injections. (Table adapted from the Clinical Guiding Principles for Subcutaneous Injection Technique).1 Children Needle size Angle of injection (degrees) Use of skin fold 4mm 90 Maybe, in 2-6 year olds 5mm 45 or 90 Yes, maybe 6mm 45 or 90 Yes 8mm Use not recommended for pen needles, can use with syringes if used at a 45-degree angle with a lifted skin fold. 12mm Use not recommended Very slim adults Needle size Angle of injection (degrees) Use of skin fold 4mm 90 Maybe 5mm 45 or 90 Yes 6mm 45 or 90 Yes 8mm 45 Yes 12mm Use not recommended Adults of Normal Weight Needle Size Angle of injection (degrees) Use of skin fold 4mm 90 No 5mm 90 Maybe 6mm 90 Yes 8mm 45 Yes 12mm Use not recommended Adults who are overweight or obese Needle size Angle of injection (degrees) Use of skin fold 4mm 90 No 5mm 90 No 6mm 90 Maybe 8mm 45-90 Yes 12mm Use not recommended RETAIL PHARMACY • JUL 2020 engage with patients who inject insulin. Pharmacist engagement can benefit patients by providing advice in the pharmacy or by onward referral to ensure therapy is optimised and complications reduced. Re-education of insulin injection technique can lead to improvements in glycaemic control.16 Pharmacists can ask a number of open- ended questions when prescriptions for insulin are filled or when supplying insulin needles. Diabetes MedsChecks and home medicines reviews are also valuable avenues to use as education opportunities. Open-ended questions may help to engage patients and identify any insulin injecting complications. Conversation starters and open-ended questions to engage patients • Tell me about your insulin injection routine. • Tell me about any concerns or ask me any questions about injecting your insulin. • Tell me about where you choose to inject your insulin. • What would you like to know more about your insulin? • How are you going with your insulin injections/injection technique? • How long have you been using an 8mm/6mm pen needle? • How many times do you use your needle before changing it? • Do you know anything about 4mm pen needles? • Have you heard about the new recommendations about pen needles? • When was the last time you saw a diabetes educator? • What issues do you experience when injecting your diabetes medication? • Where do you inject your insulin? • How do you keep track of your injection sites? • How often do you have a hypo/very low blood glucose level? There are several key points that would trigger a pharmacist to refer a patient to seek advice from their diabetes educator, endocrinologist or GP.