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.

[morte, LPN, LVN]

it is entirely dependent on the "quality" of your tech.......the computor linked glucometer is also a good thing...makes it harder to lie. I think most of us can remember a tech or two, lying about VS or something else...if not personally, it has been mentioned here at AN more than once......the last two hospitals that i worked at (none particularly recent) the techs did routine blood sugars.....but they were long term, well trained, ACCOUNTABLE sorts of persons......Out of curiosity, on what basis did the NY bon decree this?

[criticalHP, MSN, RN]

Michigan

[criticalHP, MSN, RN]

Michigan is mixed. I've worked at big hospitals that allow techs to do fingersticks, and small ones that only the RN do figersticks. I have always found it frustrating that some techs would not report hi or low to me, but would chart it. While charting a hi or low is required, a verbal on all critical values is also reuqired-do all techs kow this? Apparently not. I think RN's should be responsible to obtain fingersticks- it is ultimatley going to require the RN attending to the pt, and in this way it is done without delay in needed treatment.

[Tait, MSN, RN]

Michigan is mixed. I've worked at big hospitals that allow techs to do fingersticks, and small ones that only the RN do figersticks. I have always found it frustrating that some techs would not report hi or low to me, but would chart it. While charting a hi or low is required, a verbal on all critical values is also reuqired-do all techs kow this? Apparently not. I think RN's should be responsible to obtain fingersticks- it is ultimatley going to require the RN attending to the pt, and in this way it is done without delay in needed treatment.

99% of everything with a patient requires the attention of the RN ultimately.

Tait

[blondy2061h, MSN, RN]

Our aids can't do fingersticks, but we actually draw a plasma glucose off of the patient's line for most of our glucoses.

[WalkieTalkie, RN]

Our aids can't do fingersticks, but we actually draw a plasma glucose off of the patient's line for most of our glucoses.

Heh, your lab must be a lot faster than ours... or do you actually have a bedside machine that can interpret plasma glucose instead of whole blood? If we ever have to draw hourly glucoses, we are usually drawing another one before the first one's results are even posted. *sigh*, I know, and I do work at a major medical facility.

[blondy2061h, MSN, 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.

How many patients do you have? I usually have 1-4 patients and definitely have time to do my own glucoses, even for those on insulin drips. Our insulin drip protocol has recheck frequencies from 20min to 3 hrs. Even for our drip patients, if they have a central line we draw the blood for them off the line. It's just much nicer, and much less of a bleeding risk in our thrombocytopenic patients. I know was generally have less drips than a typical ICU, but we still have some very med-heavy patients and I've never found it to be especially burdensome to get my own glucoses. I'm in the room hourly doing something anyways.

[blondy2061h, MSN, RN]

Heh, your lab must be a lot faster than ours... or do you actually have a bedside machine that can interpret plasma glucose instead of whole blood?

No, we send them to the lab. We generally get results in 15-30 min. The 2 hours when AM labs are being drawn are the only time the lab is slower than that, generally. Our patients with actual unstable glucoses are generally on insulin drips (then we draw blood off line and run on glucometer). Our q6h glucose, SSI patients are generally just occasionally hyperglycemic from TPN and/or steroids.

[Piki]

the RNs have always done them here.

[WalkieTalkie, RN]

How many patients do you have? I usually have 1-4 patients and definitely have time to do my own glucoses, even for those on insulin drips. Our insulin drip protocol has recheck frequencies from 20min to 3 hrs. Even for our drip patients, if they have a central line we draw the blood for them off the line. It's just much nicer, and much less of a bleeding risk in our thrombocytopenic patients. I know was generally have less drips than a typical ICU, but we still have some very med-heavy patients and I've never found it to be especially burdensome to get my own glucoses. I'm in the room hourly doing something anyways.

We have 2 patients. We are not allowed to put "safe sets" on anything but arterial lines (guess our central line infection rates were going up from people improperly utizlizing it or something).

I work in a pretty high acuity unit, so it's not unusual to have a patient with a balloon pump in one room and a patient on SLED in the next, each having vasopressors which need to be titrated. I will often do my own glucoses if I'm not constantly running back and forth between the two rooms. Of course, the more pressors I add on, the more unstable the patient's sugars become, and it's also not uncommon for both patients to be on insulin gtts with Q1-2 sugars (Q2 after stable x 4 within the 70-120 range).

From what I understand, both of the situations above would be 1:1 at a lot of facilities? The only time we have 1:1s is with citrate SLED, ECMO, and our fresh heart transplants, or if someone is extremely unstable. When I have one of these patients, I will always do the glucoses because it only makes sense :)

[blondy2061h, MSN, RN]

We have 2 patients. We are not allowed to put "safe sets" on anything but arterial lines (guess our central line infection rates were going up from people improperly utizlizing it or something).

I work in a pretty high acuity unit, so it's not unusual to have a patient with a balloon pump in one room and a patient on SLED in the next, each having vasopressors which need to be titrated. I will often do my own glucoses if I'm not constantly running back and forth between the two rooms. Of course, the more pressors I add on, the more unstable the patient's sugars become, and it's also not uncommon for both patients to be on insulin gtts with Q1-2 sugars (Q2 after stable x 4 within the 70-120 range).

From what I understand, both of the situations above would be 1:1 at a lot of facilities? The only time we have 1:1s is with citrate SLED, ECMO, and our fresh heart transplants, or if someone is extremely unstable. When I have one of these patients, I will always do the glucoses because it only makes sense :)

Yeah, definitely sounds high acuity. Hope I didn't sound like I was accusing you of being lazy or anything, because I definitely didn't mean it to sound like that.

I'm not familiar with a "safe set." Do you not typically draw blood off central lines?

[WalkieTalkie, RN]

Yeah, definitely sounds high acuity. Hope I didn't sound like I was accusing you of being lazy or anything, because I definitely didn't mean it to sound like that.

I'm not familiar with a "safe set." Do you not typically draw blood off central lines?

LOL, no offense taken.

A "safe set" is an extension which connects to the pressure tubing. 10 ml of blood is drawn back into a syringe device and then locked off - that's the "waste." There are ports distal to this which blood can be obtained from with a syringe. The 10 ml of blood is then unlocked and flushed back into the patient, and then the fast flush is utilized to flush through the extension tubing. We don't access the central lines for glucoses unless it's at a longer time interval (like 4-6 hours) just because we'd be wasting 240 ml of blood a day on some of our poor patients... heh.