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 aren't passed till around 0730. As you can see this is problematic. A little background info, nearly all of our patients are on a sliding scale with Aprida and we do 12 hr shifts 7 to 7. Currently management is looking at passing the morning glucose checks to the day shift so insulin will be administered within a 15 minute window of the breakfast trays being passed.There is a lot of negative feedback from day shift. They feel that the morning hour is already too busy and they just won't have enough time to accomplish everything plus morning glucose checks and coverage.
So my question is how do you guys deal with morning glucose checks and coverage?
Who (day or night shift, RN or CNA) checks the blood glucose and at what time? who is administering the insulin and at what time? and how fast are trays received after insulin is administered?
Last edit by bclem05 on Jun 27, '12
Jun 27, '12
by loriangel14 Guide
Where I work the day shift checks the blood sugars before they eat.We start at 7:30 and breakfast comes at 8:00 so it's the first thing done after report.It works fine this way.Having the night crew do it is not a good idea if they are on sliding scale. Then I can give the insulin after the trays come.Usually they are getting it within 15-30 minutes after the tray.
at my working place, the night nurse gives the insulin before the patients have their breakfast at 08:00 hrs. but i agree that the day shift should do it. it's easier that way.
The morning shift does the check and administers the insulin as well where I work. Apidra has a before and after window in regards to eating/trays, I think of about 15-20 mins if im not mistaken.
Last edit by TiffanyRN!! on Jun 27, '12
: Reason: misspelled word
Jun 27, '12
I was working as a private sitter for a man who was moved from his home to a nursing home and sometimes the LPN would check his sugar and administer insulin with his 4pm meds for dinner at 6 or an hour after breakfast...unbelievable, right? We had a hard enough time controlling his glucose at home, where we were right on top of it, as you can imagine he has had some serious issues with spikes and drops, sometimes going as low as 29 and as high as 500!!! I'm sorry, I know this doesn't answer your question, just got me thinking about the way the nursing home handles glucose/insulin. I think it's best that the day shift does it, but I know it's hectic already in the AM. Good luck finding a system that works for everyone.
We administer insulin a little differently at my pediatric hospital, but when I did clinicals on the adult floor, the CNA/nurse from night shift would check the blood glucose around 6:00-6:30. Then the day nurse was responsible for giving the appropriate amount of insulin after they give report, which was usually around 7:00-7:30.
Jun 27, '12
Ashley pretty much stole the words out of my mouth. Some night staff check as early as 0500 and pass it on to day shift unless it's really abnormal. I try to do them at 0600 and let the day nurse know the results. I guess it works well. Days are so busy all the time it would be a lot to manage if it were their responsibility.
[font=book antiqua]i work on a 25 bed medical surgical unit and we also work the 7-7 shift. the morning blood sugars are checked by the day shift nurse (we have no pcts) and the day nurse covers them with insulin. the accuchecks are scheduled for 0800. we have time to do most things (meeting our patients, getting report, etc) before we have to do our accuchecks. the trays don't come around until almost 0900 on our floor so we don't have to rush crazy when we get here and have a diabetic.
i have also seen some of the nurses here take the glucometer and keep it in the vitals machine cart and check the blood sugars while doing vitals around 0800 as well. seems to be a good idea. good luck!
Jun 27, '12
by sapphire18, BSN, RN Guide
I agree. Have night shift check the finger sticks and day shift cover per sliding scale.
On my floor day shift does the blood glucose and insulin administration in the AM (unless someone is on a tube feeding and their blood glucose is supposed to be checked Q 6). It can be very difficult to give patient's their insulin on time. If you have 4-5 diabetics it is almost impossible.
Jun 27, '12
I 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!
Thanks 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
Never 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.