Insulin drips on the floor!

FNimuaeMae · Apr 13, 2006

Well, I worked our acute side MICU last 2 nites, with a pt on an insulin drip....all I can say is the hourly accuchecks really eat up your time, and thats with only having 2 patients! Insulin drips are a PITA.:angryfire

Missy

HappyNurse2005, RN · Apr 14, 2006

I hope you work nights, b/c a 5 or 6:1 ratio on days is inhumane, and you've got bigger problems than insulin drips!

I am on the same type of floor as you, and we occasionally have insulin drips, if they aren't d/c'd before transfer. Doesn't happen too often. Our pt's are transferred out of CSICU on POD#1(unless there are complications). Most who have insulin drip already have it d/c'd, but really, it's not that common for us to have them on our unit.

We have the portland protocol for such things, and i beleive its q1h until 2 consectutive bs are in teh acceptable range, then sticks are less often. (see, its been so long for me i dont remember the particulars!)

suzanne4, RN · Apr 14, 2006

Even it he ICU, the normal protocol is if there are no changes needed for two sticks, then the poke is every two hours.

The new literature coming out from the Society of Critical Care Medicine is recommending a much tighter control on blood sugars; you are probably going to see the insulin gtt used more and more. But to have that frequent of a check on a regular floor without a change in number of patients is crazy.

jackieRN03 · Apr 14, 2006

We are constantly running on our floor. Its hard to find time to tinkle sometimes. Suzanne, the source of the article says it all...Critical Care medicine. Surgical telemetry gets all sorts of patients, from the knee replacement getting brady to the lap chole needing IV lopressor. Its a matter of time...we just don't have it to give to one or two patients needing that close monitoring. We may lose some great nurses over this who are already stretched to breaking point!

kellyo, LPN · Apr 14, 2006

I'm a tech on our floor (RN after NCLEX!), a CV surgery stepdown unit, and our regular ratio is 1:4. When there's an insulin drip, at nurse only has a 1:3 ratio.

suzanne4, RN · Apr 14, 2006

We are constantly running on our floor. Its hard to find time to tinkle sometimes. Suzanne, the source of the article says it all...Critical Care medicine. Surgical telemetry gets all sorts of patients, from the knee replacement getting brady to the lap chole needing IV lopressor. Its a matter of time...we just don't have it to give to one or two patients needing that close monitoring. We may lose some great nurses over this who are already stretched to breaking point!

That is my point, they need to change the acuity of the floor and give you less patients. If you are going to follow that protocal, then your unit needs to have three patients per nurse, at the most four. Never, ever more if you are titrating drips, it just is not safe. I do not have an issue with those types of drips on the floor, but the unit needs to be staffed accordingly. If not, something is going to be missed. And it is only a matter of when, not if.

What I am trying to get across, as this new standard appears more and more, the units are going to have to adapt to handling patients that require the more frequesnt checks, nursing units must be staffed accordingly. You should start meetings with your manager now about it, as well a nurisng management, not wait until one morning when 1/2 of your patients are on insulin drips. You need to be pro-active, and not reactive. And have things in place for when it does happen. It is going to happen, and you will see it more frequenly, it is better to be prepared for it.

Or change your policies and procedures so that the CNA or someone with similar designation can do them. The nurse would still be responsible for the titration, but it would save you the extra minutes. A chart could be left at the bedside, and filled in hourly or every two hours.

Long Term Care Columnist / Guide · Apr 15, 2006

You can't trust management to keep the ratios at a decent level once patients with titratable drips start coming to the regular floors. My (ex)hospital did that about a year ago; having worked ICU quite a bit, I was experienced with them, but I was very much against having them on Med/Surg because I knew what would happen.

At first, management said "OK, one insulin drip counts as two patients" and told us our maximum pt. load would be 3 on days and 4 on evenings. That lasted about a month; pretty soon we had 4 on days and 5 on eves (5 and 6 respectively if we didn't have insulin gtts). Then sure enough, we wound up with 5 pts. on days---sometimes with TWO on insulin!!---and management was backpedaling like crazy: "Well, the CNAs do all the accu-checks anyway".

What they didn't take into account was the acuity of our OTHER patients, nor the fact that we had to go look for another nurse to co-sign the MAR every frickin' hour if we had to titrate:madface: In ICU we did these independently; the protocol was crystal clear, and of course everything was close by instead of down the &%$#! hall.........ah, it was a PITA. :devil:

jackieRN03 · Apr 15, 2006

We will have to take 2 pts with insulin drips and 2 more. The attitude of management is terrible. They are going into this with a "no stopping it" attitude...I think they realize its too much already. I especially hate the comments like "well you'll just have to do it" etc, because it devalues the staff nurse's opinions and knowledge and tacitly implies we would not do something unless ordered too.

I am trying to find statistics from the "top hospitals" using insulin drips on floors and what their staffing is like and how they are coping with it. I am also trying to find research articles relating to insulin drips on floors and its effect on morale. Once we have some hard facts we can go to management as a group and discuss options. Our hospital, like many others, is hoping to get magnet status but they still do not want to include staff nurses in the larger decisions that will affect them the most.

suzanne4, RN · Apr 15, 2006

Not sure if you are going to find much in the way of statistics as of yet. You are going to see an increase in the insulin drips once the new protocols are instituted in many ICUs, something that adminsitration was not prepared for, I am sure of it.

My suggestion, at least for right now, that if each of you on your floor have two patients with frequent glucose checks, perhaps one of the CNAs that have approval to do these, can be assigned to just doing those for all of you. It actually makes it easier if it is just done in an assembly line fashion, or if lab can send someone to do it. That would be the most cost effective that I can see immediately. Just the time that you waste running around looking for a machine would be removed from the equation.

UM Review RN, ASN, RN · Apr 15, 2006

We CAN do insulin drips, but thank heavens someone grew a brain and usually by the time a patient NEEDS an insulin pump, they're off to the ICU for other problems anyway.

I've only seen less than 5 on our unit since that inservice. Maybe because we put up a big stink?

Indy, LPN, LVN · Apr 18, 2006

I've had one insulin drip, I took an admission from ER, young patient in DKA on the titratable drip, Q one hour accuchecks but not on "the dka protocol" and I don't know what that is. The patient was fine but it really ate up my time. I thought, he BG is 220ish, she'll be down to normal in no time. Nope. She went up for a while then started to come back down. And I completely didn't think to have anyone else sign my mar's for the titration! I think I just put it on the insulin flowsheet for pete's sake and not on the MAR. Nothing like realizing a mistake two months after you made it. At the time I had 3 other patients, telemetry unit and they were stable.