Advancing Patient Safety and Access to Concentrated Insulin (U-500R Insulin) in the Veterans Health Administration (VHA): A Clinician Educational Program in the Primary Care Setting

This program evaluation was undertaken to improve patient safety and access to U-500R insulin by improving 'spoke' clinicians' knowledge of safe delivery and management of U-500R insulin. We created an order template for U-500R insulin, a patient education template, and pharmacy processes to ensure that all clinicians are able to co-manage U-500R insulin. The national epidemic of diabetes and the exposure of Vietnam veterans to Agent Orange has led to insulin resistance requiring concentrated insulin (U-500R) for glycemic control. Initiation of U-500R insulin is limited to endocrinology expertise housed at 'hub' Veterans Health Administration's (VHA's) located hours away from smaller 'spoke' facilities. To overcome the potential health care disparities and improve patient safety, a program was developed ensuring that all clinicians could co-manage U-500R insulin. Our program enhanced health care process and increased provider knowledge and confidence of delivery and management of U-500R insulin for veterans.