ED staff not checking blood sugars
0Oct 8, '08 by ChocoholicRNI 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 my hospital (I don't work in the ED, but a close friend does). She said that they will sometimes look at the blood glucose level when a blood panel is drawn, but unless the patient is admitted for something diabetes related they don't check fingersticks. Well this caused a problem for me the other day. I had a patient admitted for PNA who was also diabetic. While in the ED, he had a sandwich and a few snacks (he's generally well controlled at home, knows his diet). No one ever bothered to check his fingerstick, so when I checked it at night it was 426!! At home he takes a large amount of NPH BID, but had not had any that day. Of course in the ED you can't just waltz in with your own meds and start giving yourself insulin, so this guy just went ahead and ate not knowing his fingerstick since no one checked. (I know he could have asked someone, but when your starving and can't get anyones attention, you can't help it) So, in addition to trying to get his blood sugar back to a normal level, I was also going back and forth with the docs because they had the orders all wrong for his insulin compared to what he takes at home. Anyone else experience situations like this in their hospital? Thanks for the input!!
0Oct 8, '08 by Blee O'MyacinWe fingerstick. In triage and every few hours while a patient is waiting for a bed. If the house doc does the admission and the patient is being held, then they have to be the ones the write the orders.
But to answer your question, if the patient is diabetic and in one of my beds, I check blood sugar and act upon the results.
To be honest though, if I have a code or something else big and bad, the repeat bs on an AAOx3 patient will just have to wait. Sometimes they get taken to the floor first. The ED staff is not doing this intentionally to make more work for the floor staff. We can't control how many people are in the waiting room nor the flow of ambulances.
0Oct 8, '08 by mpccrnas unprofessional as it sounds, our ED nurses insist they are "not allowed" to do ANYTHING no specifically ordered by their docs.....not allowed to asses, not allowed to think, not allowed to troubleshoot. reports from them is a nightmare and frankly it's easier not asking questions because you know they won't know the answers. this has been a continuing fight between icu/sdu and the ED for as long as i've been here (5 years). the ED in not required to do anything that might be written on the admitting orders including hanging IV's even if the patient is down there for several hours because there is no bed available. i don't get it....don't understand how they hold onto their licenses, how they sleep at night, how they can go into work everyday and leave their brains and ethics at home. i couldn't do it.
0Oct 8, '08 by QuickbeamI investigate motor vehicle accidents for my state that relate to a health issue. I see thousands/tens of thousands of ER reports every year. You'd be amazed at how many ERs do not check blood glucose. I live in a state where almost 1 out of 3 adults probably have diabetes....yet this seems to get missed all the time.
6Oct 8, '08 by nursejennie76Quote from mpccrnI 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.as unprofessional as it sounds, our ED nurses insist they are "not allowed" to do ANYTHING no specifically ordered by their docs.....not allowed to asses, not allowed to think, not allowed to troubleshoot. reports from them is a nightmare and frankly it's easier not asking questions because you know they won't know the answers. this has been a continuing fight between icu/sdu and the ED for as long as i've been here (5 years). the ED in not required to do anything that might be written on the admitting orders including hanging IV's even if the patient is down there for several hours because there is no bed available. i don't get it....don't understand how they hold onto their licenses, how they sleep at night, how they can go into work everyday and leave their brains and ethics at home. i couldn't do it.Last edit by rn/writer on Oct 8, '08 : Reason: Removed unnecessary comment.
0Oct 8, '08 by CHATSDALEi would think that is one of the first things that an admitting doctor would ask for when advised of patients advmission
most ers have a protocal on patients presentind with certain complains and dx so that an assessment can be completed [triage?] even before the doc comes to see patient
a nurse should have some autonomy or you might as well hire a robot
2Oct 8, '08 by MAISY, RN-ERWe have a very busy hospital ER. Anyone complaining of syncope, weakness, cp, stroke, ams or anything else that may related to BG levels has blood done in triage. Most patients like this have an ISTAT run-so no finger stick.
The problem I see here is priorities. Fingersticks are not a priority in an emergency room UNLESS they have to do with the problem and outcome. Obviously if someone's blood glucose is elevated it is treated.
Unlike some of the others, we have standing orders. If I smell ketotic breath, the patient requests, or I feel the need I can perform a fingerstick and do. Most of the time it is my judgement. And yes, people fall through the cracks-I find them all of the time. But that is the nature of the ER, we are not supposed to be holding, we are supposed to be patching, saving and sending. Unfortunately staffing on the floors doesn't always allow it.
Again, I see another us and them situation. We are workup, emergent and sometimes maitenance. Everyone else is maitenance and sometimes emergent. A huge difference. The shame of it is, we all need each other. Look how to fix it, understand why it happens, and offer suggestions to make it better. Like better ER staffing with ancillary staff.
3Oct 8, '08 by Roy FokkerI echo Maisy.
I check sugars on all those who I think needs 'em. If they are a diabetic but appear to be hemodynamically stable, then I usually wait for the BMP to come back. If the sugar is over 180-ish or so and if the ED Doc doesn't make an issue out of it, I usually ask again just to be sure we're on the same page. Mostly I don't have to as our ED physicians (save for a couple) are totally kick ass competent
All our admitting docs ask if pt. is a diabetic and if they don't ask, I remind 'em about it and they're pretty good about ordering coverage.
And with all that being said - here in the ED we don't tend to lose sleep over a sugar of ... say... 150 or so. Same with certain other lab levels (like a K of 3.3 or some such). It's not because we are lazy or because we don't care - but these patients are stable and there is always a more emergent issue to attend to.
Quote from cheshirecatTechnically, any and all tests have to be ordered by a physician.I am a bit confused. Why do you need a doctors order to do a blood sugar?
However, most ED's usually have "standing orders" or "protocols"; and by and large ED physicians would rather have more testing done and have results on hand than the other way around.
Where I work, I don't ever ask a Doc to test someone for sugars. Or for a dozen other things - our Docs trust and rely on us to get the work ups started and we're more than happy to do so. Usually, they'll add on labs or tests - but we get the ball rolling initially. And in a busy ED like ours, we have to or the Docs would never get caught up!