High alert: prevent med errors with newer insulin products

Insulin is considered a high-alert medication, with an increased risk of causing significant patient harm when used in error. Several newer insulin products have reached the Canadian market in recent years, including biosimilars, and faster-acting, longer-acting and higher-concentration insulin analogues. Many of these newer products are also available in multiple formats (e.g., prefilled pens, cartridges, vials) and various pack sizes. As a result healthcare professionals must be alert to prevent medication errors and optimize patient safety with these newer insulin products. A recent ISMP Canada safety bulletin summarizes information on medication incidents associated with newer insulin products over a five-year period. Data were obtained from the Canadian Medication Incident Reporting and Prevention System (CMIRPS) from May 2020 to April 2025. The bulletin also shares recommendations for healthcare professionals and pharmacy teams to enhance safe use of these newer insulin products.Newer insulin productsThe safety bulletin tabulates information on the following newer insulin products: faster-acting insulin analogues and biosimilarsinsulin aspart (Fiasp, Kirsty, Trurapi) insulin lispro (Admelog)longer-acting insulin analogues and biosimilars insulin degludec (Tresiba)insulin glargine (Basaglar, Semglee, Toujeo SoloStar and DoubleStar)insulin icodec (Awiqli)higher-concentration insulin analoguesinsulin degludec (Tresiba 200 units/mL)insulin glargine (Toujeo 300 units/mL)insulin icodec (Awiqli 700 units/mL)For each insulin product, the table summarizes delivery device, concentration of insulin, volume, pack size (quantity and total volume), dosing frequency and year of Health Canada approval.Highlights of reported medication incidentsMost incidents were classified as near misses (57%; n=611) or incidents causing no harm (40%; n=421)Three percent of incidents (n=31) were reported to have caused harm.Insulin degludec (Tresiba) was most frequently reported in incidents (n=460). This may reflect its relatively longer time on the market and its classification as an open benefit across most provincial formularies.The next four insulin products most often reported in incidents were insulin glargine (Basaglar; n=311), insulin glargine (Toujeo; n=160), insulin aspart (Trurapi; n=75) and insulin lispro (Admelog; n=38).No medication incidents involved insulin icodec (Awiqli), but this may reflect its relatively short time on the market.Main themes leading to medication incidentsConfusion over the difference between clinical similarity (a designation assigned by Health Canada) and interchangeability (a designation assigned by each provincial or territorial drug information database).Failure to update the patient profile when a patient submits a prescription for a new insulin product or failure to reconcile insulin products after a switch to a biosimilar or another insulin product.Healthcare professionals being unaware of or unfamiliar with multiple and/or higher insulin concentrations, different delivery devices (e.g., prefilled pens, cartridges, vials) and various pack sizes (e.g., number of cartridges per box). One of the most commonly reported errors was a mix-up between Tresiba U-100 (100 units/mL) and Tresiba U-200 (200 units/mL) prefilled pens.Limited refrigerator storage space leading to crowding in the fridge because of an increasing number of insulin products. This may impede safe selection of the correct insulin product. Factors contributing to selection errors may include look-alike names and packaging for insulin products, and inadequate procedures for bundling and storage of filled prescriptions of insulin products. Recommendations to minimize med errors with insulin productsFor each of the preceding themes, ISMP Canada provides examples of actual errors, along with several recommendations for healthcare professionals and pharmacy teams to minimize their occurrence. Key recommendations include:Regularly update pharmacy dispensing software to include newer insulin analogues and biosimilars.Update the patient’s profile with each new prescription for insulin. Ensure that discontinued insulins and previous dosing regimens are deactivated.Incorporate an independent double check into the verification process for insulin prescriptions, as they are high-alert medications.Communicate any insulin prescription changes to the patient/caregiver both verbally and in writing (e.g., note attached to package for pick-up), to ensure they know what to expect (e.g., different delivery device, concentration, dose)Communicate insulin doses in units (not mL) to reduce the risk of dosing errors and misinterpretation across products and concentrations.During patient counselling sessions, demonstrate how to use the insulin product and delivery device to achieve the prescribed dose (in units), and use the teach-back method to ensure the patient’s/caregiver’s understanding. This process also allows for an additional check that the correct insulin product is being dispensed.Physically separate insulin products in the refrigerator to lessen the chance of selection errors.Healthcare professionals are encouraged to review their current processes and implement the improvements suggested by ISMP Canada to support and promote the safe prescribing, transcribing, dispensing and administration of insulin products. Reference:ISMP Canada. A multi-incident analysis of reports associated with newer insulins. March 31, 2026. (accessed April 29, 2026).

High alert: prevent med errors with newer insulin products

Register for free access or login.

Related Topics