Night shift giving breakfast insulins w/o tray

[findingmywayRN]

I know this is nursing 101 here, but I just started a new job at which I've been told twice (by two different charge nurses) that night shift nurses give the breakfast insulins - even though the trays don't arrive until around 8 am. At my 7 am sign off report (nights leaves at 7:30) the oncoming nurse was a little huffy that I hadn't given a patient 2 units of Reguar insulin due AC breakfast. This patient also had 8 am meds due.

Ever since nursing school I have ALWAYS brought the tray directly into the patient with the insulin, and would never dream of doing otherwise! Are other units having night shift do this, or is this just plain crazy???

[leslie :-D]

that's why i've made it priority to give a drink when doing a fingerstick.

i don't have any control over the future, but i sure do at the time i'm doing the fs.

so far, i've never had a pt who slept through this annoying procedure...

and they all seem to welcome something cold to drink, no matter what the hour.

leslie

[muffie, RN]

i give my insulins when the food is in front of the pt

[indigo girl]

Good thread and so pertinent...

In Maine, day shift gave the insulins and nights did the fasting finger sticks

in LTC. I was shocked to discover that this was not the case in Rhode Island

at all. At none of the over 50 LTC facilities that I have worked in via agency,

in that state, did days give the insulin. And I am finding this is exactly the

same situation in Connecticut also.

Like you, leslie, I give juice if I have to give fast acting insulin, and I try to

give it as late as I can, other tasks permitting.

[Dolce, RN]

I think it depends upon the kind of insulin a patient is about to receive. I would not wait until I "see the tray" in order to give regular insulin because regular insulin is supposed to be given 30 minutes before a meal. It would be completely unreasonable to say to a patient with a tray sitting in front of them, "Here is your insulin. Please wait 30 minutes to start eating." Humalog is a different class and may be given 0-15 minutes prior to meals. In that case it would be fine to wait until the tray is there before giving the food.

[kanzi monkey]

I think Q6 sliding scale checks are treated (if high) regardless of eating status--only with regular though--not rapid acting.

Lispro--standing or sliding scale--should be adjusted if the patient isn't eating. It works in 5 minutes, so the patient really should have definite plans to eat right away. If pt gets whisked off in those 5 mins, maybe give em a 1/2 cup o' milk or juice for the ride

[gentlegiver, ASN, LPN, RN]

I work LTC, the bs is tested at 6am, if coverage is needed it is given then and we retest before giving scheduled insulin. seems the safest way to do it.

[Ivanna_Nurse, BSN, RN]

We generally have sliding scale regular insulin orders with a bit of lantus at HS. Accucheks are done AC and HS if a diet is ordered, (0700,1130,1630,1930) otherwise npo pts are Q6 (6 & 12). As a nightshift person, I cover my accucheks.

If Lispro is ordered, days generally covers that with the tray. (and their own accucheks) ~Ivanna

[everthesame, LPN, LVN]

Our patients can order their breakfast tray anytime after 0600. Unless they are NPO we instruct them to call for their accu-check when they have ordered their tray and then they call when the tray arrives so we can go in and give their insulin. Our sliding scale insulins are almost always the fast acting insulins.

That said, I have worked at a hospital where nocs was required to get 0630 accu-checks and give 0700 insulin. I never liked the idea of giving juice to cover the insulin we are giving. We are trying to teach these patients how to manage their diabetes and yet we are deviating from what we want the patient to do at home. We don't teach our patients to drink juice when they take their insulin, we teach them to check their BG and take their insulin based upon breakfast.

Diabetes teaching is so very much about lifestyle modification and we should be trying to make their hospital regimen individualized and as close to their home routine as possible. Of course I am talking about stable and oriented patients. For our stable, confused patients, we order breakfast for them if they are awake and will give the insulin when the tray arrives.

[Nightcrawler, BSN, RN]

This is a big deal on my floor as well. Currently our floor policy is that fs are done at 0630 and nocs gives all insulin prior to leaving. That means that insulin is given between 0700-0730. We often have patients on very aggressive sliding scales post surgery, and it is not uncommon to have sliding scale ordered for fs of 70. Sliding scales are almost always NPH. I have never liked this practice. There have been circumstances where I have given insulins and then, as I walk off the unit I hear that trays are going to be a 1/2 hour late. This is not a hospital wide policy, but a unit one. Several of we noc nurses have been trying to get this changed, but there is a great deal of resistance from day shift, who are reluctant to take on any additional tasks. A major part of the problem is that all of the day shift charge nurses and one of the noc shift charges have been on the unit for 20 + years so we find that fighting the status quo is even more difficult.

[kanzi monkey]

This is a big deal on my floor as well. Currently our floor policy is that fs are done at 0630 and nocs gives all insulin prior to leaving. That means that insulin is given between 0700-0730. We often have patients on very aggressive sliding scales post surgery, and it is not uncommon to have sliding scale ordered for fs of 70. Sliding scales are almost always NPH. I have never liked this practice. There have been circumstances where I have given insulins and then, as I walk off the unit I hear that trays are going to be a 1/2 hour late. This is not a hospital wide policy, but a unit one. Several of we noc nurses have been trying to get this changed, but there is a great deal of resistance from day shift, who are reluctant to take on any additional tasks. A major part of the problem is that all of the day shift charge nurses and one of the noc shift charges have been on the unit for 20 + years so we find that fighting the status quo is even more difficult.

How can NPH be a sliding-scale insulin? It will not directly treat a high blood sugar--it won't take effect for 8-12 hours or so.

[Dolce, RN]

I never liked the idea of giving juice to cover the insulin we are giving. We are trying to teach these patients how to manage their diabetes and yet we are deviating from what we want the patient to do at home. We don't teach our patients to drink juice when they take their insulin, we teach them to check their BG and take their insulin based upon breakfast.

Diabetes teaching is so very much about lifestyle modification and we should be trying to make their hospital regimen individualized and as close to their home routine as possible.

I agree with this 100%. I cannot understand why juice should be given with insulin if the patient is hyperglycemic. Out of all of the BGs that I check throughout the day the vast majority are high, not low. For hypoglycemia juice is definitely in order. But it doesn't make any sense to give a sugary drink to a diabetic as you are giving them insulin. It would be a better idea if they need something to drink to give them milk or water.

[mesixfuture]

Our morning insulin is usually profiled by pharmacy @ 0700. And that's

a huge gray area of whose responsibility it is to give. Dayshift clocks in at 0645, but nightshift doesn't clock out until 0708. Trays, however, don't come until 0730. I compromise by doing the fasting right before I leave, but I refuse to give the insulin without a tray present especially since my diabetics are either postpartum, antepartum or pediatric. Our cafeteria isn't the best in the world. Some peoples trays get mixed up and have to be sent back, or sometimes the food is so bad the pt refuses it. It scares me to think what would happen if nightshift gave all the insulin and walked out before the trays even came.:uhoh21: