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.

Specializes in Clinical Research, Outpt Women's Health.

Well sure it is a good idea......

But what the OP stated is that it is pretty much an impossibility at her work where the only other nurse is far away or even on another floor and she has 9 people to manage just diabetes meds wise.

They are really putting you in a sucky position and you have my sympathies. If instituted respond in writing about why it is impossible to comply with unless they change staffing patterns.

To ChicagoPeds- Your reply was kind of disjointed, so I don't know exactly what you were trying to say. I just want you to know that the patient ratio in vogue today of 1:4 or 1:5 in the hospitals is a peice of cake . When I worked in hospitals, years ago we were assigned 10-14 pts. Beleive me the acuity was just as high. No wonder other nurses think you are goofy, because you are one of the new breed of nurses that can't handle any more than 4 or 5 pts. OMG! No wonder insurance rates have gone thru the roof. As you get more experienced you will realize you can handle more than 5 patients. Best wishes to you - I really don't eat my young! I hope you do well in your career.

Insulin double checks began back in the old days when they had beef insulins, pork insulins, plus human, and each of those had the long acting/shortacting/midacting types, and then each of THOSE had 40u/ml concentrations or 60u/ml, or 100u/ml, and you had to pair the correct syringe (in units per ml) with the right insulin, and only then would you be looking at the number of units drawn up in the syringe. It was a damned complicated business. Especially when you factor in "rainbow coverage" which was a sliding scale based on a glucose strip that would change color to reflect how much or how little the blood sugar was. No machines that spit out a number. You had to stick the pt, put the blood on the paper, wait so many seconds, wipe off the blood, wait so many seconds again, then read the strip within a certain amount of time or start from the beginning.

In nursing school a diabetic patient was enough to enduce a nervous breakdown the night before. You were certain to get a 30min verbal quizzing before breakfasts were out. Even seasoned nurses took their time matching pt to insulin, to syringe, to correct type/concentration of med. Right now you've got the glucoscan that spits out a number, easy as pie, all insulins are 100u/ml-you could use just a 1ml syringe to measure.

I think the time when insulin was the most complex drug is long past. Down with (mandated) double checks!

This is really interesting and very relevant. Thanks for sharing Canoehead!

Do most people here still Draw up insulin in an actual syringe?

Specializes in Medical Telemetry.

we have to double check our insulin doses even for 1 unit. our narcotics we dont have to have a witness unless we are wasting. another nurse has to sign our waste and witness it. i think this is a good and safer way to practice in theory, but really, when everyone is in a rush they just sign the waste or the insulin without even looking at it. if a nurse says "can you sign my one unit" than chances are that nurse is not going to make sure that its really one unit. and more times than not when a nurse says "im wasting 3mg of morphine can someone please sign for me?" a nurse will walk over and sign it without looking....so, i dont really know how effective this is.

Specializes in Medical/Oncology, Family Practice.

We double check insulin, heparin, coumadin, lovenox, pca's, tpn's, chemos..... our list goes on, all are labeled high alert. We use our computerized charting to co-sign, and don't have to have someone co-sign at the exact time we mark it off as done. We are supposed to check our co-signature list daily and agree/disagree with what we have been marked off with.

BTW, we just recently (a few months ago) changed to insulin pens instead of needles and syringes, so we are getting used to it, but it is so much quicker than drawing up and chasing down insulin vials! It is funny, though, our new grads struggle with drawing up in syringes for the one or two insulins we don't have in pens!

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.

I would love to have another nurse around to double check insulin doses, but, as many of you know, many LTCFs are understaffed as it is. That's why it's odd that a LTCF, where nurses have upwards of 30 residents, would require double checks for insulin. Especially on the 11 to 7 shift, where, based on many posts on this site, often only one nurse is in the facility. Who is she expected to double check with?

Specializes in Ortho, Neuro, Surgical, Renal, Oncology.

My magnet hospital has a PYXIS(machine with drugs in it) where we have to have another nurse witness our withdrawal of insulins. Not only does the witnesser have to have her badge and/or id # but we scan our fingers too. It's a big waste of time but it is there because people have made mistakes.

Specializes in ED, Med-Surg, Psych, Oncology, Hospice.

"Do most people here still Draw up insulin in an actual syringe?"

I assume this post refers to insulin pens.. Personally, if someone comes in with their own insulin pen I still draw the dose out with a syringe. Have seen too many high sugars after administration with a pen that my person conclusion is too many times the needle on the pen is not getting under the skin well enough. Just my opinion.

I read a forum here on allnurses where people posted their med errors. The vast majority of med errors that hurt people had to do with insulin.

That convinced me of the wisdom of double checking.

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Silly me, I thought that double checking was for the patient's safety.

I have double checked for as long as I can remember. That includes insulin, sliding scale over 5 units, (and that was back when we did URINE S&A's), heparin and dopamine drip calculations, blood transfusion protocol, narcotic waste (eyeballing the actual waste or I won't cosign). Etc, etc, etc.

My husband takes Lantus 60 in the am and 15 in the PM and I make him double check with me even though he gives himself the injection. He has insulin resistance and is also on Januvia and Glucophage.

I had a patient who took 200 units of NPH. YES Two hundred.....Rx by an endocrinologist...That was a while back though.

I know of a situation where an experienced RN flushed a central line with 10,000 units of heparin. Yes those tiny bottles do look alike don't they? Didn't something similar happen with Dennis Quaid's babies a few years ago?

If you are in an LTC situation, I would hope that this isn't a knee-jerk response from management while not providing you Nurses with adequate staffing to carryout the double check.

OMG, I hope there are not very many nurses out there that really can't draw up ( for example 8 units of insulin -in an insulin syringe marked off in 100 units per cc.) That's 8 little lines. DUH! It makes me worry about what else they are responsible for if they can't do a simple computation like that. Maybe I'm wrong about what I said before, and the nurses that are graduating today REALLY DO NEED their insulin double checked by another nurse. It scares the h*** out of me. I have been a patient many times over the past few years, and it's stuff like this that puts me into a total panic when I am a patient. Good luck John Q. Public.

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