double checking insulin doses

  1. I am trying to update our hospital policy and procedure on medication administration. What is the current standard ( in hospitals around the country) on double checking Insulin and Heparin doses with two RNs before administration. It seems pretty "passe" in nursing today because these two medications certainly aren't the most dangerous medications we give to patients. What are other hospitals doing???
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  2. 13 Comments

  3. by   monica f
    There is no policy in my facility stating that you must double check insulin or heparin, but most of the nurses including myself do double check insulin. We do this just to cover our tails. I do not know of anyone in my unit that double checks heparin though. I hope that this information helps.
  4. by   egmillard
    In the UK, most places double check heparin and insulin doses when give IV, subcut Heparin is not double checked, however subcut insulin is. Within the paediatric field all medications are doubled checked and so are controlled medications.
  5. by   CEN35
    well I work in an er. However, to my knowledge, nothing other than blood is double checked in our facility.

    Rick RN CEN
  6. by   ShannonB25
    In my nursing school I have been taught to double check all Insulin with another licensed nurse. Around here it is hospital policy to perform this measure. I will continue with this practice regardless of policy as a means of covering myself in our "sue-happy" world. Those extra seconds could make a big difference in the long run.
  7. by   ICUNurse
    Originally posted by egmillard:
    In the UK, most places double check heparin and insulin doses when give IV, subcut Heparin is not double checked, however subcut insulin is. Within the paediatric field all medications are doubled checked and so are controlled medications.
    I work in a large Intensive Care Unit in the UK and believe me, everything imaginable is double-checked!!

    We double check all IV drugs and have to see them actually being set up for administration.

    We also check all controlled drugs and watch them also being administered, IV,IM or orally.

    We also double check all flushes eg 0.9% saline, all nebulisers, eg salbutamol, and even enteral feeds. And definitely subcut heparin and insulin!

    In fact we are encouraged to have all drugs checked if we can.

    Can any area beat that?


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  8. by   ICUNurse
    Originally posted by egmillard:
    In the UK, most places double check heparin and insulin doses when give IV, subcut Heparin is not double checked, however subcut insulin is. Within the paediatric field all medications are doubled checked and so are controlled medications.
    I work in a large Intensive Care Unit in the UK and believe me, everything imaginable is double-checked!!

    We double check all IV drugs and have to see them actually being set up for administration.

    We also check all controlled drugs and watch them also being administered, IV,IM or orally.

    We also double check all flushes eg 0.9% saline, all nebulisers, eg salbutamol, and even enteral feeds. And definitely subcut heparin and insulin!

    In fact we are encouraged to have all drugs checked if we can.

    Can any area beat that?


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  9. by   justanurse
    At our hospital, we double check insulin and heparin. There is a place to sign on our nurses notes to show we've double checked out heparin drips, the rest we mark on our medicine sheets. There has been one bad incident involving heparin in the past. Without going into details, lets just say: SOMEONE should have double-checked that dose. Always double check: CYA!
  10. by   JillR
    In the hospital I work at it is in our policy to double check insulin doses. However there is really no way to prove that we did this except to depend on the other licenced nurse to remember it if there are questions regarding the administration of the insulin.

    I have noticed that not all of the nurses in our facility do this as I am often on the floor with one other nurse and know that some of them never ask me to check a dose with them.
  11. by   LRM
    Yes ICU nurse, oz has similar policies. ALL injections (IV, IM, SC) MUST be double checked. This includes heparin, insulin, flushes, ABs, flu injections on ward, you name it, its checked if it goes in parentaly. Even though legally (under the drug & health act)it is not required, I know of no hospital/instituion where this isn't policy & doesn't happen & all nurses willingly get another RN (or medically endorsed EN)to check the med. sheet with the drug. (only exceptions are some rural areas where only one nurse is around)

    Also, all S4 drugs (narcotics, controlled, dopamine, fentanyl, ect) must be double checked, signed for & witnessed (pt ID & administration) by 2 RNs (including discarded portions)

    ALL paediatric drugs are tested (from paracetamol to morphine)

    WHY all this checking? It safe guards the pt, it safe guards the nurse. We are taught in nursing school, even if it your best friend is giving the drug (eg: pethedine) you always go with them to witness it drawn up & administered, it is accepted & standard practice down here. (maybe some incidences in the discussion about nurses & drugs may be avoided if this practice was standard)
  12. by   nightshifter
    I work med-surg in southern Illinois. The only things we double-check are blood products, narc wastes, chemo, and nurse preparation of IV piggyback meds (not IV push).

    On one hand, I like the idea of double-checking everything because it would have to cut down on errors, but on the other hand I can't figure out how in the world you could get anything else done. It's hard enough to find a free hand to help reposition a pt, much less witness every med given!
  13. by   ERIsland
    What amazes me when I read these bulletin board replies about checking Insulin and Heparin is the number of people who don't seem to know that policy and procedure is what governs your scope of practice. When in doubt, look it up. Our hospital has a policy regarding checking these drugs, and while they may not be the most dangerous drugs nurses give, they are important and different doses give different results! Standards of Care and Policy and Procedures are there for a reason!
  14. by   pjhopfer
    Originally posted by ERIsland:
    What amazes me when I read these bulletin board replies about checking Insulin and Heparin is the number of people who don't seem to know that policy and procedure is what governs your scope of practice. When in doubt, look it up. Our hospital has a policy regarding checking these drugs, and while they may not be the most dangerous drugs nurses give, they are important and different doses give different results! Standards of Care and Policy and Procedures are there for a reason!

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