[kels764]

My supervisor wants me to check my patient's blood sugar bid before his tube feedings. He is a child and I have no permission slip from parent stating it's okay, we have something from the doctor that comes around the school once a week that says we were allowed to check it once...my supervisor insists that I could lose my license for NOT checking it (her explaination: common nursing sense) ...I still do not feel comfortable checking his blood sugar without doctor orders (it has dropped to 33 before after I fed him)...but everytime I ask about it, she starts raising her voice at me and tries to tear me down...I don't know what to do...please help (links to something that says I shouldn't do it...or something that says it's okay to do it would be great...)

thanks!

[maestrotee]

In my understanding, blood glucose monitoring is a perfectly acceptable nursing measure to rule out hypoglycemia in a patient that might present with symptoms (non-responsiveness, diaphoresis, etc.) but a routine screening would be super easy to get as a doc's order ... just a phone call away. I guess I'm not quite sure why your sup is so reluctant. Tube feedings DO need consistent blood glucose monitoring, without a doubt, and I would be reluctant to be giving them without it and are, as a result, just as easy to back with a doc's order. Doctor that comes around to the school? Are you in a hospital or school? Just a little confused, I guess.

[caliotter3]

Why don't you just voice your concern to the doctor and ask for an order? The doctor would most likely be glad to comply. If the doctor doesn't approve, then he could answer accordingly, and you would have something to show your supervisor. I would do this in order to cover myself since you don't have a specific permission slip from the parents.

[kels764]

I work in a school for developmentally delayed children...Im going to try and get in contact with his doctor..I just graduated nursing school in december (if you couldn't tell..lol) and my supervisor is making me a nervous wreck...I wish there was a hotline that I could call and they could answer my question haha..but I don't guess there is..thanks!!

[Fiona59]

Would you hesitate to check the child's sugars at other times? What if he was pale, sweaty and disoriented, would you want an order?

You need to build your confidence and decision making skills. But by all means leave a request for the Doctor to write the order.

[Jules A]

Hi,
I never really thought about it but I'd also think it was part of a nursing judgement. I am curious about his bgs dropping after eating as I would have thought his levels would rise after eating. ?

[KaroSnowQueen]

Checking a patient's blood sugars if need be is a common nursing judgement and you do not need a dr's order. If you are concerned, by all means, call the doc and get an order. But you don't need it to check a sugar on a patient.

[pagandeva2000]

I am also curious as to how the blood sugar dropped so low after a tube feeding. However, there are plenty of times, that you can check glucose without an order. As stated earlier, if the patient became symptomatic, what would you do...especially if you do, in fact, have to call the doctor, ambulance or parent? They would want objective facts; vital signs, what you see, and that is something that is obtainable.

[NancyNurse08]

At my facility, blood glucose monitoring (i.e. AC & HS) is a doctor's order.

If you suspect hypoglycemia, you can certainly do a fingerstick and check the CBG. That would be considered a "Nursing Action" and you do not need an order to do so.

But for the patient to be getting regularly scheduled fingersticks requires an MD's order.

[kels764]

Originally Posted by Fiona59

Would you hesitate to check the child's sugars at other times? What if he was pale, sweaty and disoriented, would you want an order?

You need to build your confidence and decision making skills. But by all means leave a request for the Doctor to write the order.

I feel confidence has nothing to do with it. I'm confident that I rightfully question whether or not I need a doctor's order. If the child was pale, sweaty, and disoriented..I would check it without a thought...because that's an emergency and I would be covered. I just was taught that you need a doctor's order for anything invasive. I've called my state board and they said there were no parameters for ME as an LPN, but it would fall on my supervisor.

Thanks for everyone's help