Where do Insulin Gtts go in your facility?

  1. 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.
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  2. 23 Comments

  3. by   nursenatalie
    We had a DKA and insulin gtt on our surgical floor this week, we dont like too but with the bed crunch it happens sometimes
  4. by   Spidey's mom
    Rural nursing . . . . we take care of them in what we call "Acute" but it is essentially "med-surg". Have a couple of chronic DKA'ers . . . . arrgghhh!

    steph
  5. by   RN-PA
    We had our first insulin gtt a couple of months ago-- at least the only one I've ever heard of in my past 10 years on med-surg. The patient wasn't in full-blown DKA, but his blood sugars were all over the place, and generally high. When I worked the weekend he was still a patient, the insulin gtt had been stopped for a day or so, and I was under the impression that we weren't supposed to have insulin gtts on the floor. Q1h Accuchecks and 6-7 patients is just too much. Never had an inservice or went over protocol, but when I inquired later, a nurse educator said yes, we could have insulin gtts on the floor. The patient also had a potassium of 6.2 I had to deal with, was morbidly obese, and his roomate was on a heparin gtt with DVT's throughout his body-- a veritable time bomb, IMHO.

    BUT, there were no beds on telemetry or ICU. (When we asked the Cardiologist about the DVT patient being transferred, he responded, "There are no other beds. You know CPR, don't you?" :angryfire ) When I had to call the diabetic patient's doc the 2nd time in the shift about a blood sugar >400, he wanted to re-order the insulin gtt to which I responded, "I'm not even sure we're allowed to have them on med-surg" and of course he was surprised since the patient had had one a day ago..... :stone He ended up giving us SQ insulin orders after I explained the nurse-patient ratios and the acuity of this patient (treating hyperkalemia, etc.).

    I'm still not totally sure what the policy is, but I'll be calling my manager on Monday to clarify-- Thanks for reminding me, and sorry for being so long-winded!
  6. by   moonshadeau
    They are a medical patient in my facility so they can go to any of the medical floors. Only to an intensive care unit if they are comatose or have some other serious comorbidity.

    It does suck to have to do hour BS checks and adjustments and carry 5-8 other patients. It is very unsafe at times.
  7. by   zambezi
    I believe all of our insulin gtts are in the unit only (last I heard anyway)
    There is a big push here to start gtts if necessary as it has greatly shown to decrease morbity and mortality...only some of the docs are on board with this thought though...we use it quite a bit in the CCU that I work in.
  8. by   CougRN
    ICU only at our facility.
  9. by   lsyorke
    ICU for us too!! Never on a med surg floor!
  10. by   Katnip
    We do ours in our intermediate care unit. Never in med/surg.
  11. by   Spidey's mom
    We don't have an ICU. Used to have a 4 bed SCU (special care unit) but we are such a small hospital it wasn't cost-effective so those nurses joined the rest of us. We have 15 acute beds, 4 with cardiac monitors. Usually 2 RN's or 1 RN and 1 LVN and then one or two CNA's. ICU style patients get flown to bigger hospitals. But we do insulin gtts, dopamine gtts, dobutamine gtts, etc.

    steph
  12. by   critcarenurse16
    Quote from moonshadeau
    They are a medical patient in my facility so they can go to any of the medical floors. Only to an intensive care unit if they are comatose or have some other serious comorbidity.

    It does suck to have to do hour BS checks and adjustments and carry 5-8 other patients. It is very unsafe at times.
    In my hospital insulin gtts are in the ICU. We have a six bed unit staffed with two RN's so the patient-nurse ratios is much less than med-surg. It is bacause of the need for freq FSBS that they are in our ICU.
  13. by   telenurse04
    I took this for granted. I work on Telemetry and we do use insulin gtt when they are ordered.
  14. by   BuffaloLPN
    we have DKAs all the time. qhr bloods drawn and physically taken downstairs to the lab, with a full assignment!

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