I am the only nurse getting high blood glucose numbers

[ricksy]

Okay guys. I am a 48yr old new nurse...hired by a LTC that I like. I DO KNOW HOW to take blood glucose ... so that is NOT the problem. I am 2nd shift and have a pt who has DR order to call him if BS is above 400. I do accu-check before supper around, say 430pm. The last three times I have worked, and done the check, I have gotten counts OFF THE charts..in high 400's and once even not countable on the monitor. Protocol is to call Dr. and family...adminster as perscribed...chart, recheck in two hours...chart...and fill out lots of paperwork. When I called the Dr second time he seemed surprised. The family asked if "what are you feeding him". I even recheck when they are that high. I think the nurses that I work with are accountable and professional...but why am I the only one to get high counts.../ Hmmmmm...help!

[Katie13LPN]

So they are being given Insulin when they do not need it? That is really scary.

[sallyrnrrt, ADN, RN]

Let me see if I understand,

This resident is frequently getting very high readings when you take them, but not when others are taking them?

I take it that there are others that take his BG at the same time of day as you (just other days)?? If this is the case...

My guess, they're not actually taking his BG.

Sad to say it, but I see neglect like this frequently.

i wish this was not the case, but it was the first thing that came to my mind also :

[ricksy]

So, guess what? I looked at the shift before me and the nurse marked the accu check at not done....patient refused......this guy is mrdd and likes to hit and smack. I have been a nurse for 2 months and I have always managed to get a ready...hmmmm...tomorrow when I get time I will check to see if the others marked it this way.

[singingtothewheat]

Best practice does in fact show that wiping away the first drop of blood is the appropriate way to collect a blood glucose sample. The alcohol wipe does contain enough sugar to change the blood glucose reading. In the U.S. most of us have a policy that says the site should be prepped with alcohol but generally outside of the mainstream healthcare system, patients often simply wash the area with soap and h20.

[singingtothewheat]

I would talk to your D.O.N. about this immediately. Unfortunately, I too have seen that some nurses seem to write in things like "refused by patient", "off floor". I realize that sometimes this is the case but when it happens over and over it looks really suspicious.

Get your D.O.N. to investigate what is going on with the patient. Does he need more teaching? Does his family need more teaching? Can the doctor intervene? Or is this b.g. just not being done?

[chrisrn24]

So guess what? I looked at the shift before me and the nurse marked the accu check at not done....patient refused......this guy is mrdd and likes to hit and smack. I have been a nurse for 2 months and I have always managed to get a ready...hmmmm...tomorrow when I get time I will check to see if the others marked it this way.[/quote']

I believe that.

We have a few patients who tend to refuse care/meds/treatments from certain nurses. Will be combative (kick hit yell) but if a nurse they like comes in and tries, sweet as can be they are! It isn't always even the nurses' approaches but rather than person thinking "ok I know nurse x, I'll let them touch me."

[BrandonLPN, LPN]

I would talk to your D.O.N. about this immediately. Unfortunately, I too have seen that some nurses seem to write in things like "refused by patient", "off floor". I realize that sometimes this is the case but when it happens over and over it looks really suspicious.

Get your D.O.N. to investigate what is going on with the patient. Does he need more teaching? Does his family need more teaching? Can the doctor intervene? Or is this b.g. just not being done?

Frankly, I would be very wary of "going to the DON" with suspicions that other nurses on other shifts are faking or skipping glucoscans.

First of all, you don't really know anything. You weren't there. There's a very fine line between "suspicions" and "idle speculation".

Second, unless you're the unit manager or something similar, policing other nurses' work habits simply isn't your job. Your manager can see all the "just below 400" blood sugars and overabundant "off units" for herself. Let her do her job and peruse it if she wants to. A good manager is already reviewing documentation on a semi regular basis, right?

Third, I said it before and I'll say it again: If you assume the worst of your coworkers and go straight to management with every suspicion, you will be in for one unpleasant and drama-filled career. Talk to your coworkers first before going to management. You owe them that as a professional courtesy.

[kaylincoln1]

In nursing school we were taught not to use the alcohol wipes b/c it can give an erroneously high blood sugar and especially if the alcohol is not dried properly. We were taught to have the patient cleanse their hands with soap and water and then dry or u can use a clean towel or 2x2 to clean their finger. I always do this and most patients always ask, why I am not using the alcohol wipe like everyone else and I always have to explain.

[ricksy]

everyone, I know about the wipes and the high counts..that was not my point

[BrandonLPN, LPN]

everyone, I know about the wipes and the high counts..that was not my point

Yes, but there could still be a logical explanation for the differences besides "they're making numbers up".

There's a good chance the other nurses simply check their blood sugars at a slightly different times when they work. The residents could be eating different things when you work. And it's really possible that it's no more than sheer coincidence.

At any rate, since you don't really know one way or the other, the most prudent course of action is to keep your speculation to yourself.

[crynyce]

Hmmmmm..... I don't know how to say this but I've worked at a facility in the past where the nurse training me told me not to call the doctor because the patient always runs high. He asked me " Do I really want to waste my time calling the doctor and doing all the extra charting? " Maybe this could be the case. I've also been in situations where the nurse told me not to give the patient all the coverage because it is better for them to be a little high then to drop later. Sometimes you have to use your nursing judgement. If the patient is Asymptomatic,put in 398, have them drink water and give them their coverage and move on to the next. So sorry but it happens all the time. If you are the regular nurse, you should know your patients better than the doctor and the orders that he wrote.

[nursejami]

Avoid squeezing the finger to get the drop bigger. Easier said than done, especially with a fast clotter, but if you "milk" the finger to increase bleeding, you will also squeeze lymphatic and extracellular fluid into the sample, which can change the results.

The director of our lab actually lists this as rationale for wiping away the first drop of blood (in addition to alcohol contamination). The trauma caused by fingerstick causes the first drop to be contaminated with extracellular fluid. The glucose in extracellular fluid is different than blood, so it skews the results.