Where do Insulin Gtts go in your facility? - page 2

Does an insulin gtt automatically mean a transfer to critical care? Or can it be managed on med-surg? Obviously, full-blown DKA is a critical care situation. Thanks.... Read More

  1. by   zacarias
    We have insulin gtts on our general medical floor all the time. It's a pretty good protocol that our hospital has set up with a whole bunch of different algorithms. A lot of times, docs will put people on insulin gtts when they have no idea what their insulin needs are or whatever. If I know a patient is going to be eating or if they don't have psycho blood sugars, I try to discourage the docs from putting them on an insulin gtt and instead to write SQ orders.
  2. by   caroladybelle
    Quote from 3rdShiftGuy
    Does an insulin gtt automatically mean a transfer to critical care? Or can it be managed on med-surg?

    Obviously, full-blown DKA is a critical care situation.
    .
    Both should go to ICU but......basically they go wherever the Heck the MD leaves them.

    I've had Q1Hr Accus on Insulin drips, on a floor where I had up to 11 patients. The patient had no hands, and had lost most of the toes. We were doing accus on the forearms.
  3. by   critcarenurse16
    Quote from zacarias
    We have insulin gtts on our general medical floor all the time. It's a pretty good protocol that our hospital has set up with a whole bunch of different algorithms. A lot of times, docs will put people on insulin gtts when they have no idea what their insulin needs are or whatever. If I know a patient is going to be eating or if they don't have psycho blood sugars, I try to discourage the docs from putting them on an insulin gtt and instead to write SQ orders.
    Just curious... why would docs do insulin gtt on someone well enough to eat? This would make me question the need for a continuous gtt. It just seems to increase risk to patient safety. I would discourage the gtt too-glad you're thinking even if the docs are not.
  4. by   mattsmom81
    Wow, I guess it depends on how time consuming the patient is. If it's a fairly stable patient with just BS a bit out of whack we put 'em on tele. They have techs there who can help with those hourly blood sugars. If there are severe electrolyte imbalances, DKA with AMS they need to be in ICU IMO, but we also struggle with the bed situation at times.

    In ICU our IM's have a DKA protocol we use following anion gap, glucose and lytes and have standing orders to treat...makes it easier to handle all around. I can't imagine trying to manage all this stuff and calling docs 5 times a shift for orders from the floors. These patients keep me busy in ICU and I only have 2-3 patients to deal with.

    Med surg nursing today is such a challenge. I could not handle it I know. Hats off to you guys.
  5. by   altomga
    the intermediate floor I work on is the "primary site" for insulin gtt's. (medical IU)..the icu's of course do them if needed and the other IU's can; they just don't like them....The gen-tele floor can do them (they are 1:4 now), but it must be on a different basis...to where the FSBS are q4h...our floor used to do q1h, but now we do q2h...makes a huge difference!!! Even with a 1:4 ratio. med/surg floors should NOT have to take insulin gtt's; they have enough pt load already to have to worry about getting FSBS q1-2-4 whatever.
  6. by   talaxandra
    I work on a medical specialty ward that includes endo - unless they're really sick (eg pH <7.05) we manage them here. The hourly everything's a pain, but we also take renal transplants immediately post-op and they've got more going on. Don't get me wrong, I'm well aware of just how unwell a DKA can be, but we have a great protocol, a heap of experienced nursing staff, fantastic (mostly) medical staff, and accessable consultants. Maybe it's the general hospital acuity, or the smallness of our ICUs, but if the DKAs went to ICU we'd have no room for the really really sick patients!
  7. by   VivaLasViejas
    A while back, we experimented with doing insulin gtts on Med/Surg, but since it basically required 1:1 nursing and most of the M/S nurses never got comfortable with them, it was decided to do these only in the ICU. In those days, I was one of the only nurses who did feel OK with it, so I ended up taking these pts. just about every time we got one.....I enjoyed it, but with 5-7 other pts. it was unsafe. Nowadays I get pulled to the ICU sometimes when there's a pt. in DKA who's on a drip, and when I do I have only the one pt., or maybe two if the other pt. is comparatively stable. I'm definitely NOT an ICU nurse---vents scare me---but I do like the challenges of titratable drips, it's really rewarding when you get to see dramatic improvements in the patient's condition.....and it's a test of skill when things don't go the way they're supposed to!
  8. by   Tweety
    Quote from altomga
    the intermediate floor I work on is the "primary site" for insulin gtt's. (medical IU)..the icu's of course do them if needed and the other IU's can; they just don't like them....The gen-tele floor can do them (they are 1:4 now), but it must be on a different basis...to where the FSBS are q4h...our floor used to do q1h, but now we do q2h...makes a huge difference!!! Even with a 1:4 ratio. med/surg floors should NOT have to take insulin gtt's; they have enough pt load already to have to worry about getting FSBS q1-2-4 whatever.
    I wish wish wish with all that is within me that we had an intermediate unit in our facility but we don't. Our ICU is jam packed with vented sick and trauma patients. So it's hard to get a bed. I had to start a gtt the other day with no ICU beds. We did the accuchecks q2h. I put the patient in a 3:1 assignment for day shift. Of course they had a cow (this on a floor that's telemetry and has stable vented patients. Go figure), but when I came back 12 hours later, they didn't have any luck finding an ICU bed. That particular day ER had 4 vented trauma patients awaiting beds, etc.

    Problem is there is no set policy. We took an insulin gtt a few weeks ago out of ICU when they needed the bed. My manager was fully aware of this and accepted the patient. So who do you think had a cow when I started the gtt? The manager of course. Seems like she just makes things up as she goes along and forgets what she does the day before. No one can give me an answer. We have protocols on our unit as to what to do with a gtt. I've seen many gtts on the floors over the years and am fairly comfortable with them, if I have proper staffing. However, not everyone is.

    Thanks for your response. I'm going to advacate in our next meeting to get a definitive answer from the facility. Fair weather policy that is made up as you go along is getting on my nerves. (Also this manager wanted to start a Dopamine gtt on our unit once, but now is saying she doesn't like insulin. Sheesh.)
  9. by   MandyInMS
    If your facility is like ours..they change the rules as they see fit..seems one time xxx is NOT allowed on the reg floor..but push come to shove and no ic bed available guess what? we get stuck with it....grrrrrrrrrr
  10. by   Tweety
    Quote from MandyInMS
    If your facility is like ours..they change the rules as they see fit..seems one time xxx is NOT allowed on the reg floor..but push come to shove and no ic bed available guess what? we get stuck with it....grrrrrrrrrr

    Exactly. grrrrrr... :angryfire
  11. by   ?burntout
    Quote from mandyinms
    if your facility is like ours..they change the rules as they see fit..seems one time xxx is not allowed on the reg floor..but push come to shove and no ic bed available guess what? we get stuck with it....grrrrrrrrrr
    ditto...ditto....ditto

    we have not had an insulin gtt in forever (knock on wood) on our unit, but it has been done. but usually if they are dka they are in the unit. it is too unsafe to have q 1hr fsbs and then 4-5 other patients.... :uhoh21:

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