ED staff not checking blood sugars - page 2

by ChocoholicRN

2,188 Views | 17 Comments

I was just wondering, if a patient comes to your hospital and part of their history is diabetes but that is not part of their primary diagnosis, do you still check their fingerstick? I just found out that this is not protocol at... Read More


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    We do stat fingersticks on diabetics with symptoms (such as dizzy, increased urination, etc). If we get a pt who is confused, has a decreased level of consciousness, is having seizures, etc - then we get a stat fingerstick too. If the pt is at the ED for a med refill, their blood glucose may not be checked. This may sound sad, but some ED docs hate it when we go "fishing" because if the pt's fingerstick is way off, then the doc has to treat it (and I'm not saying that that's the right thing to do, either).

    If we have a pt being admitted with a history of diabetes, we definately get a baseling blood glucose. If their admission is unrelated to diabetes, we may or may not recheck their blood sugar before they go up to the floor (depends on the length of time they're in the ED). Most often, our ED docs will permit a pt to eat but won't start giving them insulin because they don't want to be chasing low blood sugars on a pt with a bed waiting upstairs and an admitting doc already writing orders for the floor.

    The only time we give insulin is if the person is in DKA or if their blood glucose is way too high (or if the pt's potassium is sky high, but that's a whole different story).

    Things can change so fast in the ED; one minute you have time to check a blood sugar, and the next minute you have the hall beds full with a PNB 5 minutes out. Increased blood sugar after eating is not a priority at that point in a pt who is asymptomatic.

    We truly do some amazing things each day in the ED. It seems like ICU and floor nurses hate the way we do things in the ED - but truly, we start with a blank slate and work our way up and do our best to patch the pt up before transfering them to a different department. The other night, I was treated like dirt by some ICU nurses after transfering a head bleed pt; he was very hypertensive, confused; I was 1:1 with him and went to CT with him, worked on managing his BP and educating the family, I got his old records faxed from a different hospital, gathered his med list to the best of my ability, placed another IV, removed a different IV that he had pulled out, prepared for intubation, placed a third IV, labeled my IV lines - and when I brought him to ICU and passed his copied chart to the nurse, I said "I've also included his records from xyz hospital" - I was ignored and they slammed the door in my face. So, I turned around and ran back to the ED to see how my other 4 pts were doing, only to be placed with another head bleed ready to go to the OR...
    Blee O'Myacin and gonzo1 like this.
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    The protocol in our ER is to do an accu check on all DM pts at triage.
    Now,..if there are 20 more pts waiting to be triaged and the pts c/o is not related to mental status change, weakness etc, they might not get an accu check at triage. That is part of prioritizing care, I'm not real concerned about a glucose of 300 if I have two chest pains, pt with L facial droop and someone bleeding all over the floor that I haven't even triaged yet.

    If a pt is being admitted and has orders that say it's okay for him to eat,.most of the time that pt will get an accu check,.especially if he/she is on insulin,..but again,.priorities here,.if we are full of traumas and MI's, in all honesty, it might not get done. That's the frustrating part of the ER,.we have no control over when our pt's show up, and can't ever say we are full no more. It isn't uncommon for us to have pt's in the hallways and EMS calls with two more traumas,.we just have to put more in the hallway and do the best we can. If we have to make a choice of getting an accu check on bed 7, and getting bed 8 to cath lab,.bed 12 to the scanner and hanging blood on bed 5,.the accu check often has to wait.
    Blee O'Myacin and MAISY, RN-ER like this.
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    Quote from nursejennie76
    I dont know where you work, but I am a great ER nurse, and I work with great ER nurses, and I will hang meds on the admitting orders, I assess my patients, and know more about them then the ER doc does!! So please dont bash all ER nurses!!! By the way I sleep well at night, and will have no problem holding my license, you probably could not handle 2 hours in a busy ER!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    thanks for your attention to detail! i specifically said "our ED nurses", not ALL. i also specifically said "when a bed was unavailable for hours". i would enjoy getting report from you. it would be a pleasure to get report from someone that actually assesses their patient in the ED. perhaps you could give our ED staff some tips. we haven't been able to get them to understand a baseline assessment of the system the patient is being admitted for is extremely important i.e. the neuro statis of a patient being admitted for a cva. don't get so defensive next time. it wasn't a bash to all ED nurses. the faster we understand that team work transcends floors and departments, the better off our patients will be.

    oh, by the way, been there, done that... i worked a trauma center ED and held my own rather nicely.
    canoehead likes this.
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    When I was an EMT, part of our protocol was to do a blood glucose on anyone with an altered LOC. Why would we do this on someone who was clearly injured in an MVA? Because you don't know whether the crash was the primary event or a result of someone who was already altered.

    With so many undiagnosed diabetics walking around, doing a blood glucose in the ED might catch the condition for the first time. I'm with Roy in saying that mild elevation isn't a cause for alarm--although it can certainly be an invitation to follow up once the excitement has died down--but you can see some amazing numbers in folks who have no clue that they have a problem.

    In one EMT case, I recall a relatively young man who felt sick on the job. He was a big guy and his s/s suggested a possible MI. We did a fingerstick as a "rule-out" kind of thing and got a reading in the 680s. His heart was fine. His blood sugar was in orbit. He'd obviously been diabetic for some time, but he had no idea. It's conceivable to me that he could have gone through a detailed cardiac workup, and when nothing heart-related showed up, he might well have been sent home with his diabetes still undiagnosed. I'm sure this happens more than we like to think.
    Roy Fokker and Quickbeam like this.
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    My friend is involved in a lawsuit. Her husband came in to ER twice with NV and flu like symptoms. No one ever checked his blood surgar no way, no how. They just kept treating him for flu. He was a 40ish male of a from a group that is know to be diabetes prone. He was finally diagnosed with diabetes after his health was seriously harmed by a extremely high blood sugar. I don't care how it gets check, finger stick or blood draw but it needs to be checked.
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    Quote from cheshirecat
    I am a bit confused. Why do you need a doctors order to do a blood sugar?

    Surely it is part of the job of treating the whole person? Does it require a docs order to do ob?
    I'm a little confused by that too. Our ED does do them and the nurses have standing orders for them to do it when they deem it necessary. I would think that would be standard procedure.
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    Nope, I just got "spoken to" last night for doing glucoscans without an order. Seems risk management feels that is practicing medicine without a license. Blattttt!
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    Quote from cheshirecat
    I am a bit confused. Why do you need a doctors order to do a blood sugar?

    Surely it is part of the job of treating the whole person? Does it require a docs order to do ob?
    Here in Florida we're covered and any nurse anytime can do an Accucheck.


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