No More Fingersticks for Techs!!

[pagandeva2000]

Is this happening where you all are? I live/work in New York City and work in a city hospital, and in the past few months, the BON sent a mandate stating that techs, CNAs, PCAs, etc...can no longer do fingersticks...this is designated only to licensed personnel; LPNs and RNs. Now, I am hearing from other RNs working in private industry that they are still allowing their techs to do this. Last year, they just upgraded many of our CNAs to Patient Care Associates, which was supposed to include this skill, but, now, they are not allowed to.

In addition, it causes more stress to the nurses, especially in our prenatal diabetic clinic, diabetes, endocrine and medical clinics because there are more PCAs than there are nurses. Now, I can be backed up with 8 charts, trying to push them out, and then, here comes the page: "Fingerstick in room 10" and this can go on for awhile! I emailed the BON and straight from the horse's mouth, it was told that we can no longer allow them to do so. I suspect that a mistake was made, or something was probably not reported to the nurses which had determental affects on the continuity of care. I was just curious to know if any of you are confronted with this as well.

[wooh, BSN, RN]

We can't even let techs do our first set of vital signs, because our facility decided that we have to do a set before we delegate them according to a pump and pearl's interpretation of the practice act. It's getting to where the techs can't do anything. If the armband is scanned, then you can check who the blood sugar "really" belongs to. I can come up with a worst case scenario for anything that we delegate. That doesn't mean that we have to start acting like techs are incapable of doing things. And taking tasks away from the techs will NOT get us more nurses, it will just give more work to the nurses already there. Believe me, I watch it everyday at my hospital as we take away things the techs are allowed to do, but the ratios keep going up even as the workload goes up.

ETA: Agree with above, it's just like VS. If the number doesn't make sense for the patient, I can redo it myself. What's next, I can't trust the lab with my CBC? Do I need to go to the lab and run the bloodwork myself? Nurses CANNOT do it all! We have to trust other people to help out in caring for our patients.

[boggle, ASN, RN]

Techs do fingerstick glucose checks here. Thank goodness! There are far too many to do at busy times in the shift for nurses to get them done without the tech's help. The computerized system helps avoid communication problems about who's blood sugar was what.

The glucometers are linked to the computer system. The glucometer scans the barcode on patient's writstband, so "Right Patient" is not a problem. Once the glucose checks are done, the glucometer is "docked" in it's holder. That's linked to the computer. The glucose reading, time, and patient is all immediately recorded in the patient record. Of course, the techs report their findings to the nurse, but the nurse verifies all glucose readings on the computer. The judgement of what to do about the Blood sugar reading is the nurse's responsibility.

Our techs do a great job. They use correct technique. (it's pretty hard to mess up a glucose finger stick!) Facilities need to work on making it easier to communicate the findings accurately, not add more tasks to the nurses shift.

[crb613, BSN, RN]

Nurses only at my hospital.

[WalkieTalkie, RN]

75% of our patients in the ICU have Q1-2 hr glucoses, and if they are not Q1-2, nearly all patients have at least Q4-6 hr ones. Thankfully our techs do them. I couldn't even imagine trying to keep track of everything else I do and be doing hourly finger sticks. I certainly don't mind doing them if the techs are busy, but there are simply too many, especially when my patient is on an insulin gtt.

The techs take competencies/training on this, and know when to alert the nurse, and most of them are very good about this. The glucometer is also uploaded wirelessly and its results will show up under our patient's lab values in the computer. The techs also write them on a strip of paper taped to the inside of the patient's door. I rarely have problems with techs taking glucoses, and they are able to do them in a much more timely manner than I would be able to do... especially if one of my patients is occupying a lot of my time.

[katgirl46806]

I use to think that this was okay until last Friday.I was working with another nurse and a QMA which for those that dont know is a cna who has undergone training on passing medications and has passed examination by the BON to be able to do so. I usually pass meds from 2 med carts and it is known to be the heavier med pass with numerous blood sugars, blood pressures, breathing treatments and a couple of gtubes,and temps that have to be done.I was responsible for her and they are suppose to notify the nurse of the blood sugars.Well I work in LTC and is reponsible for about 25 and about 8 blood sugars that get coverage,and are done before meals.She did 2 blood sugar checks. She told me of one but she left to help in the dining room I stayed on the floor to finish passing meds. I work evenings and dinner is served at about 545.She comes back at almost 630 and says oh by the way sos and so blood sugar was over 400 about 439 to be exact. My mouth about hit the floor.I know i should have been on top of that but i got extremely busy and i know thats no excuse but anyone who works LTC can attest.So I had to call the doctor and explain and she was thinking that the lady was having a hyperglycemic reaction which thank god she wasn't because of when i had called. So Ive learned my lesson and its fine to let them do that but it all depends on how competent that tech or QMA and if they understand the parameters involved.

[DeepFriedRN]

They stopped allowing techs to do them in our hospital a few years ago. (I'm in CA) It can get kind of crazy when in stepdown and all 3 pts have q 2 hr checks.

[lunden]

i like how u put that wooh. i work n a outpatient dialysis clinic and although we don't do fingersticks we draw blood from their arterial port and let the nurses know anything abnormal. rarely do the nurses do a blood sugar.

[Tait, MSN, RN]

Our techs do the fingersticks here in Metro Atlanta.

Our accucheck machines then report it to the computer, and our techs write it on the BG flow sheet.

I understand the concern over miscommunicated BG's, however then the same can be said for a misscommunicated BP, like I had tonight, and other vital signs.

My patient was written down at 114/61. When I went in with 80mg of Micardis for him he informed me that the first BP she had taken was 91/56! So I called and got parameters and held the med.

Same thing with a person reporting a BP of 180/78, for example, because they didn't have the person relax their arm on the bed, or because they used the wrong cuff, or because they startled the person at 0400 by flipping on all the lights instead of approaching with respect, and I go in and cover with Hydralazine, when thier natural BP may have been below the set parameter.

If no one is expected to have responsibility and accountability for thier job, all tasks will eventually fall to the first person with a liscence...the nurse.

I personally favor the idea of eliminating techs/cna's/pca's and employing more RN/LPN's to improve continutity of care, but until then we need to raise the bar on our expectations and make sure ancillary staff realizes the importance of the role they play in patient care.

Tait

[wooh, BSN, RN]

I use to think that this was okay until last Friday.I was working with another nurse and a QMA which for those that dont know is a cna who has undergone training on passing medications and has passed examination by the BON to be able to do so. I usually pass meds from 2 med carts and it is known to be the heavier med pass with numerous blood sugars, blood pressures, breathing treatments and a couple of gtubes,and temps that have to be done.I was responsible for her and they are suppose to notify the nurse of the blood sugars.Well I work in LTC and is reponsible for about 25 and about 8 blood sugars that get coverage,and are done before meals.She did 2 blood sugar checks. She told me of one but she left to help in the dining room I stayed on the floor to finish passing meds. I work evenings and dinner is served at about 545.She comes back at almost 630 and says oh by the way sos and so blood sugar was over 400 about 439 to be exact. My mouth about hit the floor.I know i should have been on top of that but i got extremely busy and i know thats no excuse but anyone who works LTC can attest.So I had to call the doctor and explain and she was thinking that the lady was having a hyperglycemic reaction which thank god she wasn't because of when i had called. So Ive learned my lesson and its fine to let them do that but it all depends on how competent that tech or QMA and if they understand the parameters involved.

So i'm wondering, how would having to do all the blood sugar checks have made you less busy? If you're too busy to follow up on them being done, doing all of them is only going to make you even busier!

[LVN-RNhopeful]

At my last hospital (I'm currently not working) our Techs did our accu-checks, and I felt very comfortable allowing them to do so. All of my techs were very prompt in reporting any abnormals. On an average night 3-4/5 of my pt's were accu-checks and I can't imagine not having my techs' help. I was very grateful for all their help and always made sure they knew how much they were appreciated. Trust me - just because an individual is licensed doesn't mean they are competent. I've worked with some RN's and LVN's that would send me running screaming from my room if I were a patient and they walked in and introduced themselves as my nurse.

[vicarious]

I am PRO CNA's/assistants taking the blood sugars of their assigned patients. We are not asking CNAs to interpret or treat a high or low blood sugar or to teach patients, so I see nothing wrong with delegation of that task. I am thankful to be assisted in this way.

I do believe that there should be a standardized rule that if a blood sugar is reported as greater than 210 or something or lower than 60 that the RN should re-take the blood sugar if pt is asymptomatic, obviously treat if emergent or symptomatic. If my patient is talking to me and seems fine and I was just told his blood sugar was 11, you bet I am calling for that glucometer and doing it myself.

And if you are AGAINST CNA's taking blood sugars and say that youre too busy to recheck the blood sugar if it falls above or below a certain point--what makes you think taking all of your patients' blood sugars will take you less time? What next, do we analyze our own CBCs too because we are anal and the lab tech may not be?

Requiring a nurse to take a blood sugar may be an issue of patient safety, but what a simple task it is.. how many things could I be doing that we cannot delegate to a CNA in the time that it takes me to do 4 or 5 blood sugars?? Could I do my assessments a bit more thoroughly? Could I be doubly sure to adminster the right meds, right dose, right patient, etc? Might I actually make a med pass on time? the list goes on!

Thank you CNAs!

[Roy Fokker, BSN, RN]

My old hospital, techs were permitted to insert foleys and do accu-checks.

Now in my ED (different state), techs can do accuchecks - no foleys.

cheers,