Drawing a Blood Glucose for a high accuchek

[mappers]

Our P&P on accuchecks says that if an accucheck is greater than 500, need to draw a stat glucose and notify MD. We have protocols for insulin, low, medium, and high that docs can order if they choose to and those say to draw a blood glucose if it is over 400 and notify the doc.

I sent an email to my manager asking for clarification since there is a descrepincy and the response was, if the docs are using the SS orders, draw at 400, if not, draw at 500 or whatever the docs write.

My thoughts, why two different numbers?? I mean if 400 is what the protocols say, then why shouldn't the P&P say the same thing? If 400 is right for one, why isn't it right for the other?

Am I missing something here?

[Ellekat]

I remember asking why lab had to redraw if a FSBS was >500 when I started nursing. At that time, the machines used for finger stick glucose levels weren't accurate at that range and a re-draw from the lab was needed to verify that the fsbs was correct. (not only to verify, but also to be certain it wasn't actually much higher). I'm guessing that when updating policy no one has addressed whether the floor blood glucose machines are more accurate than they used to be. Our policy also states to call the physician for fsbs > 400; I would think that if it's that high, the physician would want to be notified anyway so she/he can investigate why the blood sugars are so high and if the patient is in ketoacidosis.

[guest2210]

From past experience, I would do another accu check-the first result may be d/t machine error. If the 2nd is still high, then follow the protocols in place.