Management of Personally Owned Insulin Pumps for Patients at Risk for Suicide in Emergency Departments and Inpatient Units

The VA Office of Inspector General (OIG) issued this brief report to highlight a concern regarding the Veterans Health Administration’s (VHA’s) lack of national guidance regarding patients who use personally owned insulin pumps to manage their diabetes and present to emergency departments or inpatient units with suicidal ideation and are at risk for suicide.

This report is in response to an OIG inspection involving a patient with suicidal ideation who used a personally owned insulin pump to attempt suicide while admitted to an inpatient unit. The OIG learned that multiple clinical staff did not recognize the patient’s personally owned insulin pump as a lethal means (an object, including medication, that could be used for suicidal or self-directed violence) and did not remove the pump as a safety measure.

The OIG sought input from leaders of VHA National Emergency Medicine Office, VA Office of Specialty Care, National Endocrinology and Diabetes Program, Office of Nursing Service, Office of Suicide Prevention, and Pharmacy Benefits Management Services regarding patients using personally owned insulin pumps who present with suicidal ideation in VHA emergency departments and inpatient units. The responses confirmed there are no VHA policies or guidance specific to patients with personally owned insulin pumps and suicidal ideation.

The OIG concluded that VHA facilities would benefit from national guidance regarding staff recognition of insulin pumps as a lethal means and the management of personally owned insulin pumps for patients receiving care in emergency departments and inpatient units who have suicidal ideation and are at risk for suicide. Guidance could decrease the risk of patient harm, improve quality of care, and prevent patients from attempting suicide using a personally owned insulin pump in these settings.

The OIG made one recommendation to the Under Secretary for Health who concurred in principle and provided an action plan.