Having another nurse check insulin doses & other med Qs

Nurses General Nursing

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There is talk going around work that management is thinking about requiring nurses to have another nurse double-check insulin doses, meaning another nurse would have to watch one draw it up, and sign that it's the correct insulin and dose. I'm assuming this is another check to prevent med errors.

I've heard about this happening at some hospitals, but this is LTC, where we have up to 30 residents. Plus, some nurses have had up to 9 fingersticks to do. If this becomes an actual rule, med passes are going to take even longer. I can't imagine trying to track down a nurse for 9 fingersticks. :uhoh3: Do you have this rule at your job?

If this rule is done for safety reasons, then why not have a second nurse around for other "risky" drugs, such as narcotic pain meds and coumadin?

Another question: some residents have orders for narcotic gels, such as Ativan, that are to be applied to different hairless areas of the body. I'm curious: should the nurse clean the particular area of the body before applying the gel, such as the inner wrist? The instructions don't mention anything about washing the area before applicaton.

In addition, would the drug would lose potency if it was applied to the left inner wrist twice a day without washing that area between applications? I wanted to apply it on the upper back, just to rotate sites, and a nurse said it should only be on the wrists. I thought that as long as the area doesn't have hair, it's okay to apply the gel there. Am I wrong? Thanks.

I really don't understand the complaints about double checking insulin. I understand it's time consuming, but it's a necessary evil. I'm just now trying to go to nursing school, but have worked in the hospital as a pharmacy tech. I can't even describe how many times nurses have given novolin instead of novolog, mixed sliding scales, just gave the wrong dose, etc. and our hospital "double checked". When we made TPNs and drips, we had to be more careful with insulin than almost anything else. It's just one of those things that gets mixed up and messed up constantly...

I understand that med errors can happen with insulin, but the same can be said for "high risk" coumadin, or a narcotic, but no double check is needed for those drugs. (Sometimes a patient may have two different doses of coumadin in the med drawer.)

Also, med errors (i.e. wrong pill; wrong number of pills; wrong patient) can happen with any drug, and can cause harm, so why not have a double check for the whole med pass?

Specializes in LTC, peds, rehab, psych.
We have to get a second signature on any sliding scale insulin but are not required to do so for Lantus. Of course its to reduce errors but its a necessary evil and I am glad the nurse I normally have to track down checks mine just as I check hers.(yeah a huge pain as we do have up to 30 residents to pass meds on and have to take the page out of the book, take the syringe, the bottle of insulin etc) Sometimes I do them all at once and take them all with me, I have even put tape on the syringe with the persons name so I dont confuse them.. talk about time! ... I know there are some nurses at our facility that sign for each other but dont check, sorry not my policy- worked to hard to get this far!.

You know how long administration takes to implement things, well maybe not all but from where I have stood lots of talk goes on and little action is taken unless its state mandated or something of the sort..

See to me, this proves that the double-check procedure is not a good idea in a busy longtern care facility. Drawing up several insulin syringes at one time, even when labeled with tape in order to most quickly do a double-check seems far riskier and would increase insulin med errors than just drawing up the insulin one at a time and immediately giving to the patient without a second person to witness the draw.

Yes, but insulin unlike other drugs, doesn't come in single dose forms. Narcotics, etc come in unit dose packages, so it's harder to make a huge error. Also, as technology progresses, it's even harder to make mistakes with UD when pyxis or omnicell or whatever the hospital uses only allows the nurse to dispense and access what's on the patient's MAR. However, if someone gives 1mL of insulin instead of .1mL, it's going to be a huge incident.

And, in the hospital I worked in, injectable narcs were required to be witnessed...morphine, demerol, etc.

Specializes in Oncology.

It's ironic that I just whined up double checking doses in this thread, then went to work, where I got in report that a patient had "100 units" of insulin in his TPN. He had 10 units and the nurse read 10u as 100.

Specializes in PACU.
However, if someone gives 1mL of insulin instead of .1mL, it's going to be a huge incident.

1 ml = 100 units. You should be VERY cautious when dealing with doses that high, regardless of who you have available to check it. Anyone who seriously gives 100 units instead of 10 needs a smack upside the head.

I agree with the person who said that drawing up several doses and checking them with another nurse at once is more likely to lead to an error than just doing one at a time and being careful. Doing so creates several more steps of possible error--incorrect labeling, misreading the label, grabbing the wrong syringe when stressed out or tired, etc.

Double checking insulin and other high risk drugs is a great idea where feasible, but it sounds like the staffing is not adequate in many LTC facilities to allow it to be done efficiently and safely. Creating another burdensome hoop to jump through does not necessarily increase safety.

Specializes in Telemetry.

Well frankly I don't think that it is reasonable for a nurse at a LTC facility to require to check off insulin as I've heard stories of one RN having 20 to 40 pts. You would say it would lead to greater safety, but I don't see that having to check off insulin at my hospital has actually caused greater safety for the pts.

Second, I think this discussion is heading more toward the fact that it is truly silly for us to have to sign off on 2 units of aspart, but (at my hospital any way) not on the insulin drip that I just hung or the dopamine drip that I just started. Someone mentioned that narcotics are individually packaged, which is true unless the pt is getting something like Fentynal epidural. Those are used quite frequently on my floor; or the drips I mentioned before: insulin, dopamine, dobutamine, and levophed. Why don't I have to get those checked?

Canoehead was right there about WHY insulin used to be double checked as an absolute! I too remember the complicated mess insulin dosing was. There were times when the MD would order 13 units of U40, and the only insulin available was U60. This meant that the nurse had to figure out how many units of U60 equaled 13 units of U40. When I first started nursing in 1974 the only way we had in our facility to measure "blood sugar" was by the CNA obtaining a urine sample. In a test tube we put the required number of drops of urine, along with the correct number of drops of water, and a tablet. You had to time the test and compare the color of the mixture with colors listed on the bottle of tablets. You were doing well if you came within 50 points of their blood sugar. And to make things worse you couldn't hold the test tube because the mixture got very hot. Hot enough to burn you. With the multiple dosing of insulin it really did need the double check. Wlith U100 as a standard, even patients at home can figure out what to give.Pardon my language, but, it would be a **** poor nurse who couldn't figure out how to give the correct dose with U100.

Specializes in Pediatrics.

At my facility, (acute childrens hospital), we are required to watch the RN draw up the insulin, check to make sure it's the correct insulin & dosage & watch them give it to the Pt. We also do dual verifications with PCA & epidural changes(initiation, changes, d/c), TPN, IL, all blood products, (Chemo for those chemo certified RNs...I am not) and dual signatures in the record. In fact, no dual signature = no place you can document you gave the med.

If you want to get to the heart of the matter it is this: your license. If you don't want to protect yourself, your patient & your license, then that's your decision. I plan on keeping mine for awhile... Also, with all the distractions around us (call bell lights, alarms, phone calls from everyone about anything from "can you fix the tv" to MDs, child life, secretaries asking about your kiddos, etc) it is not unheard of that people make mistakes.

After all, we are all human and therefore, it is possible to make mistakes (of course, unless you are super-nurse).

Specializes in Psychiatric, MICA.

I've worked at two hospitals in my area and both require two nurses for insulin. In my current unit, the med nurses commonly handles thirty patients, but there is usually no more than a half-dozen fingersticks at most and most days only a couple. Only two patients have sliding scale coverage. The rationale seems to center around the speed at which Regular insulin works.

D

At my facility, (acute childrens hospital), we are required to watch the RN draw up the insulin, check to make sure it's the correct insulin & dosage & watch them give it to the Pt. We also do dual verifications with PCA & epidural changes(initiation, changes, d/c), TPN, IL, all blood products, (Chemo for those chemo certified RNs...I am not) and dual signatures in the record. In fact, no dual signature = no place you can document you gave the med.

If you want to get to the heart of the matter it is this: your license. If you don't want to protect yourself, your patient & your license, then that's your decision. I plan on keeping mine for awhile... Also, with all the distractions around us (call bell lights, alarms, phone calls from everyone about anything from "can you fix the tv" to MDs, child life, secretaries asking about your kiddos, etc) it is not unheard of that people make mistakes.

After all, we are all human and therefore, it is possible to make mistakes (of course, unless you are super-nurse).

YES, it is MY license and it has been queaky clean for 35years.I graduated as an LPN at the age of 19. I am now 56yo. Since I see you have been a nurse for all of 3 yrs. contact me (in another 32 yrs. if I am still alive), and tell me if you have done as well. I take care of 52 LTC patients and do most of the FSBS and SS insulin coverage. I have kept my license clean by ALWAYS protecting my pt's. best interest. My pts. frequently tell me that they are happy when they know I am on duty, and that they feel safe when I am here. This is THE greatest compliment a nurse can receive. I'm not saying I've never made a mistake - any nurse who says she has never made a mistake, is either, a liar, or too stupid to know she made one. This is supposed to be a vent site for nurses, NOT A PERSONAL ATTACK SITE, on other nurses. Most of us are talking about issues, Not maligning other nurses!!!! By the way, I have never considered myself a "super- nurse", but I am a d*** good one, and proud of it.

Specializes in Pediatrics.

fridayannelpn1974 - Firstly, I was not meaning to personally attack anyone. That was not my intention. Secondly, I have heard the craziness that nurses in the past 10 years (when the nurses on my floor were at the older hospital...before we transferred over to the nice new place) had to deal with...patient ratios, etc. They actually think that us newer nurses are sometimes goofy (for lack of a better word) for being concerned about having gone over our max ratio of 4:1 (some have been assigned 5 patients).

I started nursing when nurses have to dual-check insulin....have been at a hospital where there have been issues with pt's getting too much insulin...& not even being diabetic patients or patients who need insulin...so yeah, I am going to double check & have someone double check with me. I play by the rules...cuz when I don't...that's when I have gotten burned. Also, as already previously stated on multiple comments prior to mine, LTC is different than hospital...there are not as many nurses...and a heck of a lot more patients...(& all of them probably have way too many meds to count).

It seems that when "each person" starts in the nursing profession (different generations...), different societal/rules were in place. Different expectations were in place...and those shape us to be the nurses that we are today. (hence, insulin is a scary drug for me...because of what happened within that hospital).

Specializes in Cardiac surgery ICU.

We double checked Insulin and Heparin, and did prevent errors, but I remember when with the double check there were errors too. Also double checked children's meds.

Better be safe than sorry.

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