Delegation of insulin administration to non-registered healthcare workers in community nursing teams: an evaluation of care and practice for older people with diabetes

Community Insulin: Nurse Delegation of Injections (CINDI)

Start date

02 March 2020

End date

21 December 2021


The complexity and demand on community nursing workload is increasing as people live longer with multiple health conditions. A growing number of older people with diabetes have other conditions, such as memory loss or arthritis, which prevents themselves from administering their own insulin injections. Therefore, qualified registered nurses have responsibility for administering insulin to an estimated 10,800 people with diabetes who cannot do this themselves. With diabetes increasing faster than predicted and significant community nurse staff shortages, this represents a considerable challenge for community nursing services.

In some community nursing teams, registered nurses delegate insulin administration to non-registered healthcare workers, such as healthcare assistants, who are trained to administer insulin injections. With a national shortage of nurses, delegating insulin injections to healthcare assistants may improve service efficiency and may also benefit patients. Furthermore, extending the role of non-registered healthcare worker roles is recommended as a solution to meeting demand. However, insulin carries a risk of injury/death if misused, therefore delegation of this task requires sound governance. Organisations are developing insulin administration delegation programmes to meet service demand, although the extent of this practice is limited, and no independent evaluation has been conducted on this practice.

Research is needed to ensure that delegation of insulin administration develops and is evaluated in a way that is acceptable, safe and beneficial to older people. It is important to understand what patients think are the important issues and identify any benefits or concerns amongst staff or patients. Furthermore, it is important to gain perspectives on what works well and identify any aspects that need to be improved.

Aims and objectives

Research questions

1. What are the benefits and disadvantages, if any, for patients, staff and services when non-registered healthcare workers give insulin injections to older people with diabetes?

2. What are the most feasible types and methods of data collection that will enable a large scale, national evaluation of healthcare practice relating to insulin administration delegation practice to be conducted in the future?

The study objectives

1. Explore (i) the views and experiences of older people and/or carers receiving insulin injections (ii) other key stakeholders (including, managers, registered nurses and non-registered healthcare workers) and (iii) identify any benefits or risks relating to insulin administration delegation.

2. Collect mixed method data to inform the development for a future national evaluation study, with specific focus on sampling and questionnaire data needed to explore the prevalence and safety of insulin administration delegation.

3. Explore the feasibility of document analysis to assess organisational procedures for insulin administration delegation (including training and governance arrangements) against national guidance and patient safety regulations.

4. Assess the feasibility of collecting health economic data related to insulin administration delegation to inform a future economic analysis.

Funding amount





Resources for community nursing services and those with an interest in insulin delegation

The CINDI Project 10 TIPS on Starting Insulin Delegation

The 10 tips on starting insulin delegation is a resource that has been created to inform the future development of insulin delegation by healthcare organisations.

How the tips sheet was developed

The 10 tips were derived from experiences and research evidence on delegation from the following sources:

  1. Review of the literature on delegation of medicines administration from nurses to healthcare support workers in community settings. The paper is freely available: Delegation of medication administration from registered nurses to non-registered support workers in community care settings: A systematic review with critical interpretive synthesis.
  2. Findings from the CINDI project.
  3. Webinars featuring exemplar sites with experience of setting up an insulin delegation programme (Delegation of Insulin Administration Webinars | Diabetes UK).

The above sources were analysed, and a list of common practices were identified, along with strategies that organisations found helpful in supporting implementation of insulin delegation. The list was then consolidated following feedback from the CINDI project research team to form a draft tips sheet. This was then sent for validation and feedback from a range of informants, including: patient representatives, healthcare support worker representative, diabetes specialist nurses, delegation specialist, service managers, head of community nursing and a quality and improvement implementation specialist.  

How to access the tips sheet 

The CINDI Project 10 TIPS on Starting Insulin Delegation is free to use but we ask you to have regard to the following conditions on its use:

  1. Do not distribute this to anyone else – if anyone asks for a copy please ask them fill in the 10 tips on starting insulin delegation resources questionnaire (via the download link below).
  2. If you use the guidance, or any part of it, we would be grateful if you would please:
    1. Acknowledge the authorship team.
    2. Send copies of any reports/papers that are produced to Dr Karen Stenner (
    3. Let us have any comments/suggestions that you feel might improve these resources so that your experience can be incorporated into subsequent updates.

Download the tips sheet

Research groups and centres

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