Night shift giving breakfast insulins w/o tray - page 2

:uhoh3: 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... Read More

  1. by   muffie
    i give my insulins when the food is in front of the pt
  2. by   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.
  3. by   Dolce
    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.
  4. by   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
  5. by   gentlegiver
    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.
  6. by   Ivanna_Nurse
    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
  7. by   everthesame
    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.
  8. by   Nightcrawler
    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.
  9. by   kanzi monkey
    Quote from Nightcrawler
    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.
  10. by   Dolce
    Quote from everthesame
    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.
  11. by   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:
  12. by   Spatialized
    I wish that I could print this discussion off and show to our managers, so they would see that what we are doing is both dangerous and not part of the norm.

    We do our fingersticks between 6 & 7. Then we (the night shift) are required to give coverage for those that require it. If it is regular insulin, I don't have a big problem doing that, most of the time those on regular do not have an aggressive sliding scale. When it comes to those getting Novolog, I do it right before I clock out, usually when I see the trays coming down the hall. I give my AM Lantus between 7 & 7:30. There are days where I will not give the Novolog and pass that to the day shift. Rarely have I encountered any resistance to that, although there have been some occasions.

    We're in the process of trying to get the policy changed, but as with nay policy change it takes time. Good to see that other folks are dealing with this.

    Cheers,
    Tom
  13. by   leslie :-D
    Quote from Dolce
    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.
    it depends on what the fasting sugar is...
    i don't automatically give out juices to ea and every one.
    but the brittle diabetics, i do.
    i know how they crash and i try and anticipate this.
    if i get a fasting of 500, i don't give juice.
    but with 250, i do...again, w/the brittle ones.
    most don't have appetites so i can't count on them eating breakfast.
    it's unique to ea pt, to their hx and current status.

    leslie

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