Risky practice: Personal care workers are being asked to administer insulin

Diabetes Control
Image credit: vitapix - iStock

Aged care workers are being asked to administer insulin in the community, without being qualified or approved to do so.

HelloCare has become aware that home care workers with only Certificate III qualifications are being asked to administer insulin to home care clients. 

Being asked to perform this task is leaving workers concerned about the risks to their clients, but also about the potential risks to their future career.

Home care workers with Certificate III are only qualified to assist somebody to self-administer medications, according to Paul Gilbert, assistant secretary ANMF.

“That wouldn’t extend to giving an injection,” Gilbert told HelloCare.

“If you’re supervising someone else who gives themselves an insulin injection and is otherwise competent, that is a different question, that’s alright,” he said.

But if somebody who is not qualified is giving insulin injections they are “exposing themselves, and those they are caring for, to incredible risk,” Gilbert said.

Gilbert hopes the practice is not widespread.

A risk to accreditation

Insulin is not only being administered by under-qualified aged care workers in the community, but also in residential aged care.

Gilbert said in aged care homes, enrolled nurses or registered nurses are the only staff qualified to administer insulin medication.

Gilbert said he himself is not personally aware that personal care workers are administering insulin in aged care homes, but any homes that do carry out the practice should not pass accreditation audits.

“I wouldn’t have thought that a home that did that would survive a visit from the agency,” he said.

Insulin errors can be deadly

There are 1.7 million people in Australia with diabetes, and the risk increases with age. Of Australia’s roughly 300,000 aged care residents, it’s estimated that 10%-20% have the condition.

Because it is so common, insulin is “the drug most likely to result in an adverse outcome if it’s not administered correctly,” Gilbert explained.

Overdoses can be fatal.

Even among highly qualified nurses, medication errors involving insulin do occur from time to time, Gilbert said.

In one case, a nurse accidentally administered 44 units of insulin rather than 4 after misreading the doctor’s instructions – highlighting just how much care, knowledge and experience is required when administering the drug.

“[The nurse] should have known there wouldn’t have been circumstances you would be giving a person 44 units of insulin,” Gilbert warned.

Fortunately, dosage controlled injections have helped to reduce the risks encountered when administering insulin, Gilbert said. 

Aged care workers who only carry the Cert III qualification should speak to their manager and refuse to administer insulin until they have earned the necessary qualifications.

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  1. This is, and has always been, a slippery slope, Carer,s administering medication in Nursing Home Facilities & Home Care.
    Some Organisations have pushed for this for many years, putting the elderly at risk.
    Refuse, and theirs always someone else in the Organisation to say yes, take their place, if they say no and well, reduced opportunities for shifts ?

    Nurses make mistakes @ times, and they are qualified, and they soon learn and should learn, not to make them again.

    Heavy burden for a Carer,who makes a fatal mistake, with legal consequences, and what for the Organisation,s prompting them, they will wash there hands of that ?
    I might add, not all Organisation,s act this way.
    Well Carer, you’re going to feel very very lonely indeed.

  2. If a person was competent to administer their own Insulin they would not require supervision.
    It is a medication with the potential for unexpected outcomes. It is not the role of personal carers. It is foisted on them because the “owners” do not wish to employ more qualified professional nurses.

  3. A person with diabetes can self administer and not always under perfect circumstances, kids under ten are encouraged to manage their diabetes so surely a carer would be at least as able to dispense.

  4. I am wondering what the view is on Schedule 8 patches being adhered to by Care Workers? – they are not injected but it is a grey area also if the Medication 2x check for Schedule 8’s is not able to be done?
    Guiding Principles 4 indicate it is acceptable (but not directly refers to patches) however this guide still refer back to Legislation and internal Policies and procedures? Clearly someone in their own home cannot apply it to their back? They need to alternate where it is applied. this would seem a reasonable service if the Care Giver has had Medication administration training?

    What is the view of the specialists – is there any clear approval for this practice as an exception in people been cared for in their own homes? I cant find anything more than the Guiding Principles. The Code is also a bit cloudy with this one?

  5. I think Mr Gilbert needs to check facts before making comments. 44 units of insulin is not common but is known to be administered. Also carers are able to administer pre filled injections and insulin after training which is mostly about sharps disposal.

  6. Linda, you’re correct 44u/s of insulin is not out of the ordinary for many diabetics. However, 44u/s of say “NovoRapid” or it’s equivalent “Actrapid” is likely to be lethal. Furthermore, if a resident had an unusually high blood glucose reading ie. in excess of 25 mml/L that did not reduce by the 2nd reading it’d probably be prudent to send the person to ED, don’t you think?? No one other than a doctor should be fiddling around with insulin when they have absolutely no idea what any of these figures mean. Let’s face it, doctor’s don’t always write up a sliding scale and even if they do, would you want a PCA to be interpreting the order? No thanks, they’d probably decide to give jelly beans or Lucozade in the mistaken belief the resident was at risk of a hypo!! It’s risky, that’s why insulin should be checked by 2 nurses and delivered by an RN or EEN.

  7. Refuse until you have the necessary qualifications? There you go guys! Get ready for it. AINs will still be working for peanuts and if it isn’t bad enough being made to do Registered Nurses work like giving out medications that was a no no once, now insulin? This is abuse of aged care workers. We never signed up for this!Is this a third world country? It is obvious to me that women (as it is mostly women) in carers employment are being forgotten and thrown aside with our elderly beside us. The future for nurturers in any caring capacity is at risk in the near future unless wages and conditions in this workforce see women as important assets looking after the disabled and vulnerable elderly. Otherwise our children will need to look after us in their homes meaning more women will suffer the consequences of poverty in our most productive years without a working wage!

  8. I have administered 44 units and above It is not unusual if is a long acting insulin like Lantus, Novamix etc
    You would not be giving 44 u/s of short acting insuling like Novarapid (unlike Novamix) Its possibel the order was for 4 u/s of Novarapid or if 44 of Novamix the nurse gave the Novarapid instead which would be fatal

  9. Untrained disability support workers are injecting Santinex, an appetite suppressant.
    I thought a chemical that alters behaviour is a restrictive practice AND apparently an RN can delegate authority to inject substances to clients.
    Appears, it all depends on whether people turn a blind eye, or don’t like you, whether if’s an issue.


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