Who is accountable?

[TigerGalLE]

Do CNA's and PCT's work under our license? I am just wondering because a few days ago one of my patients recieved too much insulin due to a PCT's error. The PCT told the nurse the wrong blood sugar for a patient. The nurse covered the blood sugar (which was like 350) with humalog. Later it was realized that the patients blood sugar was really 200ish. The PCT got the rooms mixed up!! The nurse called the doc and everything. Well when I came on and recieved report I immediately rechecked the patient's SQBS. It was 40!!! I had to start an IV and push D50. If something would of happened to this patient, who would of been accountable? The PCT or the nurse?

[olol765]

I was under the impression that we are responsible for our own licenses. Just like we don't work under the doctors license....

[DEB52]

Our PCA's are trained to do fingerstick B/S's and every year they are tested on this on an education day. Patients do there own B/S's also so it should not be an issue if they can do it but the individual PCA'S skills. Hopefully, these issues were addressed with the PCA , the nurse and someone in management. There are some very good PCA's working out there. And I appreciate very thing they do.

[Tweety, BSN, RN]

Here in Florida, the Nurse Practice Act is pretty clear....it's the RN. However, also here in Florida it's rare, if ever, for a nurse to get into trouble based on the scenerio you desccribed. If there were a sentil event, i.e. the patient went into a coma and died based on the insulin given, the nurse would have more than likely had a good defense before the BON, and would have been o.k. after an investigation.

The only thing that would have gotten the nurse in trouble would be if there wasn't a policy in place for PCT's to do accuchecks, and/or there was no documentation this particular CNA was competent. Delegating tasks that the CNA's that don't have documented competency can get you in big trouble.

[TazziRN, RN]

I was under the impression that we are responsible for our own licenses. Just like we don't work under the doctors license....

Techs and CNAs are certed, not licensed. They work under their own certs but some things are done under the RNs' licenses.

[RNsRWe, ASN, RN]

The techs that do the accuchecks in my hospital have been trained to do so by the hospital education dept, have passed the competency test, have been authorized by the hospital to do the checks as required on each unit, and to give accurate readings to the nurses.

The nurses act on those readings and give insulin accordingly.

If we've delegated a task to an individual who has proven competency and is authorized by the hospital within their job description to do that task, we are not responsible for mistakes on their part. I will not be held accountable for someone having received too much or too little insulin if the information provided to me was inaccurate (and the person providing it was delegated to appropriately). It is not a "med error" if my administration is based on incorrect data, any more than if a lab value is incorrect and based on that the MD orders a bolus of something or a transfusion of something. I can only act on the information provided to me by competent individuals. If THEY screw up, that's their heads.

While most people will say we are responsible for every action taken by a person "under" us, who has been delegated to do a task, the reality is the BON would have to want to see US hang for something the aide did wrong (who has done it for xx period of time and always does it correctly). And that's just not realistic.

[Myxel67]

I agree with RNsRWe. CNA's don't perform as nurses and don't work under the RN's license. Student nurses work under the license of their instuctor because they are not yet licensed, are performing functions of a nurse, and are being supervised by the instructor.

[RN BSN 2009]

I agree with RNsRWe. CNA's don't perform as nurses and don't work under the RN's license. Student nurses work under the license of their instuctor because they are not yet licensed, are performing functions of a nurse, and are being supervised by the instructor.

That's not true, nursing students do not work under their instructors license.

[Myxel67]

this scenario is exactly why i get my own blood sugars and do all of my own insulins....

it's important to be able to trust other team members and delegate tasks appropriately. cna's/pct's are human too and are not infallible--everyone makes mistakes.

[AnnieOaklyRN, BSN, RN, EMT-P]

I think it would depend on whether the CBS was documented incorectly by the PCT. With a verbal report alone there is no proof that the wrong CBS info was given by the LNA/PCT

Sweetooth

[RNsRWe, ASN, RN]

I think it would depend on whether the CBS was documented incorectly by the PCT. With a verbal report alone there is no proof that the wrong CBS info was given by the LNA/PCT

Sweetooth

Does anyone work in a place where there is no paper trail, that it's only a verbal report on something like that? It's hard to imagine...our techs have many FSs to do at specified times; it's recorded on a sheet and the charge nurse writes that info down on HER (or his) brain as well. Nurses take that number off the sheet, and do what's needed on our end. Different units have different paper systems, but there's always a paper system, can't imagine a tech pulling a scrap of paper out of her pocket, reading me a number, and stuffing it back in her pocket. If nothing else, wouldn't I need THAT piece of paper to remember who needs what?

Our glucometers also have a recall function to find out what a pt's BG was the last time it was drawn. I don't know how much info it holds, but I know that's one of the reasons it's there.

[TigerGalLE, BSN, RN]

Going back and looking on the glucometer works well if you forget the sugar you took. Our glucometers store the SQBS by the patient's ID number, so it is very helpful and accurate. But nobody has time to go back and check behind the PCT to make sure the sugars are correct. I hope this was just a fluke situation that won't happen again.

[RNsRWe, ASN, RN]

Going back and looking on the glucometer works well if you forget the sugar you took. Our glucometers store the SQBS by the patient's ID number, so it is very helpful and accurate. But nobody has time to go back and check behind the PCT to make sure the sugars are correct. I hope this was just a fluke situation that won't happen again.

Oh, I'm totally with you there. I just brought up the glucometer storage thing in response to someone's post that if there's only a verbal report on the number, how is there proof of who screwed up. But I can see that that ISN'Tproof.....drat.