Coordinating insulin admin +/- 15 mins of tray being passed - page 2
Hi everyone, my question is on how you deal with morning glucose checks and insulin administration? I work on a busy tele floor where the night shift is currently doing the morning glucose checks and coverage around 0600, trays... Read More
- 0Jun 27, '12 by threebrats46I am night shift and we do the same schedule as you. I can't speak for the rest of my coworkers but I really keep an eye on my patients. If I note a fingerstick of less then say 80 I give juice when I give coverage bc we give coverage between 6a-7a and trays are passed around 8ish. Sometimes I reschedule for day shift to give coverage if I am really concerned. Dayshift nurses tend to give me heck about the reschedule but it is best for the patient!
- 0Jun 29, '12 by bclem05Thanks for all the responses! As I assumed the overwhelming response seems to be that day shift is giving rapid acting insulin in proximity to the patient eating. One thing I haven't given enough thought to is having night shift check sugars and day shift give the insulin. Seems like a good compromise in time saving and best practice/ patient safety. Although I do wonder how other nurses would feel giving insulin based off a sugar that was taken 30 mins -3 hours prior? On the safety side, I suspect the glucose level wouldn't change much over this period of time and by giving the insulin with meals would we would negate the majority of if not all hypoglycemic events.
Thanks for everyone's input
- 0Jul 2, '12 by CDEWannaBeNever give insulin based on a reading more than 30 minutes old. Frankly, I wouldn't dose off a blood sugar check more than 10 minutes old.
Blood sugar is constantly changing and am results can be affected by long acting insulin taken the day before and by the natural rise in blood sugar we all have called Dawn Phenomenon where the liver releases stored glucose, causing an am blood sugar rise.
- 0Jul 2, '12 by hecallsmeDuchessOn my unit, if the pt is AC/HS the day shift does a total of three blood sugar checks and administers insulin as needed per sliding scale or however it is scheduled, then the night does one check and covers accordingly. We were told we are not supposed to administer insulin if the blood sugar has been an hour old, and are asked to recheck the sugar if it's been an hour before then administering insulin. This causes a few problems because sometimes the CNAs want to do sugars at 7am, trays might not show up till 8:30 and so on. Usually, when I have diabetic pts, I ask the tell the aides to do the sugars at 7:45, sometimes they agree but other times they hesitate. When they are unwilling, I ask them not to do it and get it myself because ultimately I'm responsible for the pt.
Our night shift usually gets sugars around 8pm, then give HS snacks and insulin as needed. The pt receives no other check (unless something out of the ordinary happens ie symptomatic hypoglycemia) till dayshift checks it before breakfast. The biggest headache is unreliable meal times, if we can get the a set time for meals, it'll help out a lot and we might have tighter blood sugar cotrol on the unit.
- 0Nov 14, '12 by Anne36When I was in Nursing school we were told to wait until the tray is in front of the patient. Well, I have over 20 patients to give dinnertime meds to, and 6 of them are Diabetics who need sugar checks and insulin with dinner that is served at 5:30 in 2 different dining rooms or someone may decide to stay in their room. So, Im doing a half dozen people who need their pills, checks and insulin all at the same time. I do the best I can, but I cant be in 6 places at the same time.
- 0Nov 16, '12 by classicdame GuideI think the nurse who will be feeding the patient should give the insulin. There is no quarantee that the tray will arrive exactly at 0800 or any other time. The best solution I worked with was in a pedi hospital. The trays were delivered to the NURSE, not the patient (we had a special area). The nurse then took the tray with the insulin and glucose meter to the patient. Not always feasible, I know, but we never had issues with hypoglycemia that way