[alintanurse]

Originally Posted by grannynurse FNP

Most states do not require a prescription for insulin. It is important, that upon discharge, a patient be aware of what type of insulin their doctor wants them on and at what dosage. And I believe it is up to the nurse to ensure that the doctor writes an order, so that the nurse can know. A prescription is required for the syringes. I do not uinderstand how a patient could not know he/she was not a diabetic, when receiving insulin. That is the fualt of both the physician and the nurses caring for him/her.

Denise

The patients believed that they only needed the insulin while they were in the hospital because they had never needed it before. I think sometimes the hospital nurses think the homecare nurse can take care of the patients needs........but let's be reasonable! Anyway, I have always needed an order for insulin so I'm not sure what you mean that a prescription isn't required.

[NancyJo]

Nursing initiates diabetic teaching for new diabetics while inpatients here. What it usually amounts to here though is having the pt. return demo accuchecks, drawing up insulin and administering the insulin. Often done in a day or two, not really enough time to give adequate training. We do not have a specific education plan for diabetics, I wish we did. I would like to see a flowsheet or a checklist to keep track of what has been covered, since often our assignments may change and sometimes I will get a pt. for the first time on the day of discharge. Most do chart, but face it some are better at documeting then others and sometimes it's difficult to know just how comfortable the pt. is with the info provided. We have an excellent dietician whom I always have come to see my diabetics and she does a short class with them. She also brings a packet catered to their diet plan, sample menu, portion sizes, etc which is written in very simple terms and the diet is simple to follow.
We have educational videos that I offer, but very often pt.'s decline, so usually we talk. We also have access to micromedex which has a section for discharge information for aftercare. It is written in layman terms which I print for pt.'s to read prior to discharge so that I can answer any questions they may have. I also print up the info on their particular insulin or oral hypoglycemics. I work with an RN who is a diabetic educator, and I try to get her in to answer any questions they may have, that of course depends on how busy she is, but she always makes an attempt. I try to do as much as I can before they leave, because it's difficult to get people to do any f/u after discharge. Not sure how many if any insurances cover as outpatient diabetic teaching. I went through diabetic teaching when I was a gestational diabetic years ago and it was all covered, but when a few years later I was diagnosed DM I had my doc send me to the dietician for a refresher course and this insurance(a different one than before) didn't cover it at all and it all came out of my pocket, so I think that is why so many don't follow through.
We also have to have a prescription here for insulin.

[alintanurse]

NancyJo, I'm sure what you do for your patients is greatly appreciated. A homecare nurse that might follow your patients then would have an opportunity to build on the teaching that you have started.

[grannynurse FNP]

Originally Posted by alintanurse

The patients believed that they only needed the insulin while they were in the hospital because they had never needed it before. I think sometimes the hospital nurses think the homecare nurse can take care of the patients needs........but let's be reasonable! Anyway, I have always needed an order for insulin so I'm not sure what you mean that a prescription isn't required.

An order for insulin is different from requiring a prescription for a patient. One can walk into any pharmacy and pick up a vial of insulin. Why are you blaming the nurse? It is the failure of their physician to tell them they need to go on insulin, not the nurses. However, the nurses have failed in part, because they did not bring it to the attention of the physician.

Grannynurse

[grannynurse FNP]

Originally Posted by NancyJo

Nursing initiates diabetic teaching for new diabetics while inpatients here. What it usually amounts to here though is having the pt. return demo accuchecks, drawing up insulin and administering the insulin. Often done in a day or two, not really enough time to give adequate training. We do not have a specific education plan for diabetics, I wish we did. I would like to see a flowsheet or a checklist to keep track of what has been covered, since often our assignments may change and sometimes I will get a pt. for the first time on the day of discharge. Most do chart, but face it some are better at documeting then others and sometimes it's difficult to know just how comfortable the pt. is with the info provided. We have an excellent dietician whom I always have come to see my diabetics and she does a short class with them. She also brings a packet catered to their diet plan, sample menu, portion sizes, etc which is written in very simple terms and the diet is simple to follow.
We have educational videos that I offer, but very often pt.'s decline, so usually we talk. We also have access to micromedex which has a section for discharge information for aftercare. It is written in layman terms which I print for pt.'s to read prior to discharge so that I can answer any questions they may have. I also print up the info on their particular insulin or oral hypoglycemics. I work with an RN who is a diabetic educator, and I try to get her in to answer any questions they may have, that of course depends on how busy she is, but she always makes an attempt. I try to do as much as I can before they leave, because it's difficult to get people to do any f/u after discharge. Not sure how many if any insurances cover as outpatient diabetic teaching. I went through diabetic teaching when I was a gestational diabetic years ago and it was all covered, but when a few years later I was diagnosed DM I had my doc send me to the dietician for a refresher course and this insurance(a different one than before) didn't cover it at all and it all came out of my pocket, so I think that is why so many don't follow through.
We also have to have a prescription here for insulin.

If you don't mind me asking, where is here? I have lived in two different states, plus traveled and never had to have a script for insulin. For my syringes yes but insulin no. Most states do not require insulin prescriptions, so I am wondering which one you live in, that does?

Grannynurse

[alintanurse]

Originally Posted by grannynurse FNP

An order for insulin is different from requiring a prescription for a patient. One can walk into any pharmacy and pick up a vial of insulin. Why are you blaming the nurse? It is the failure of their physician to tell them they need to go on insulin, not the nurses. However, the nurses have failed in part, because they did not bring it to the attention of the physician.

Grannynurse

I was mainly speaking about a patient who is now insulin dependant being sent home without necessary DM supplies or the proper teaching to manage his condition. I have a problem when a glucometer,syringes and insulin have not been arranged before discharge. Every pharmacist I have ever called regarding insulin needs has always needed an order or prescription. I have never had a pharmacist say it wasn't necessary.

[NancyJo]

Grannynurse,
I work in Illinois. We have to have the script for the insulin and syringes also.

[grannynurse FNP]

Originally Posted by alintanurse

I was mainly speaking about a patient who is now insulin dependant being sent home without necessary DM supplies or the proper teaching to manage his condition. I have a problem when a glucometer,syringes and insulin have not been arranged before discharge. Every pharmacist I have ever called regarding insulin needs has always needed an order or prescription. I have never had a pharmacist say it wasn't necessary.

Most states do not require a prescription for insulin, although there are a few that still do. My physician furnished my glucometer, for free, to me. And a script for my insulin. My diabetic teaching consisted of having a person come up, hand me a few sheets of paper and asking if I had any questions. Fortunately, I didn't have that many questions and knew where I could get the necessary information. Unfortunately, most new diabetics are not nurses or don't have a nurse friend or family member. I go to some of the diabetic message boards and am amazed at the amount of misinformation that is posted. And the focus on having the lowest blood sugars and not eating enough carbs. It is unreal.

Grannynurse

[nursethumper]

Originally Posted by grannynurse FNP

Most states do not require a prescription for insulin, although there are a few that still do. My physician furnished my glucometer, for free, to me. And a script for my insulin. My diabetic teaching consisted of having a person come up, hand me a few sheets of paper and asking if I had any questions. Fortunately, I didn't have that many questions and knew where I could get the necessary information. Unfortunately, most new diabetics are not nurses or don't have a nurse friend or family member. I go to some of the diabetic message boards and am amazed at the amount of misinformation that is posted. And the focus on having the lowest blood sugars and not eating enough carbs. It is unreal.

Grannynurse

I am not even a nursing student yet and know all too well the pitfalls of diabetic education to new or otherwise established diabetics, Type I and II. As I see it this inadequacy needs to be addressed yesterday. DM will be the new plague in only a matter of a few paltry years. We as nurses cannot assume a pt knows anything and I do not find it surprising that a pt taking insulin not know they are diabetic. How many pts have you had that seem to be ignorant of what we know /consider basic info??? Have you ever seen someone who thinks a double quarter pounder, lg fries and a coke is an ok lunch or dinner?? Remember that if you assume you run the risk of making an @ss- (out of) u and me . Or worse run the risk of not giving needed info to someone whose health will be at serious risk. Or make sure they understand that info. As to an actual diabetic educator, in my area it takes up to 6 months to get an appt. and it is MHO that it is the ability of these educators and not the Dr to truely "control" the sugars of many DM pts. And I know w/o being told bedside nurses don't have the time but the system does need improvement and I think the checklist is an excellent idea- at least each nurse would know what has been covered and understood. I plan to do this in my own head so to speak when I am a practicing nurse (which I hope is soon). Just a thought or two (I have MORE) from the daughter of a Type I and a type II.

[alintanurse]

Originally Posted by grannynurse FNP

Most states do not require a prescription for insulin, although there are a few that still do. My physician furnished my glucometer, for free, to me. And a script for my insulin. My diabetic teaching consisted of having a person come up, hand me a few sheets of paper and asking if I had any questions. Fortunately, I didn't have that many questions and knew where I could get the necessary information. Unfortunately, most new diabetics are not nurses or don't have a nurse friend or family member. I go to some of the diabetic message boards and am amazed at the amount of misinformation that is posted. And the focus on having the lowest blood sugars and not eating enough carbs. It is unreal.

Grannynurse

Unfortunately, your experience has been a bad one--as you can see from my previous answers you are not alone. I can say that at the agency I worked for we did indepth teaching using written materials and demonstration along with NCP's. Nursing educated the patient on DM diet,portion size,s/s hyper/hypoglycemia and actions to take,what to do on sick days,foot care/skin care,meds,when to notify MD. Our dietician reviewed each patients diet and physical status including lab results and made appropriate recommendations for better blood sugar control. Also upon discharge from homecare services the patient would be directed to classes offered by local hospitals that usually were free.