I am the only nurse getting high blood glucose numbers

  1. 0 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!
  2. Visit  ricksy profile page

    About ricksy

    Joined Mar '11; Posts: 117; Likes: 139.

    47 Comments so far...

  3. Visit  3aremyjoy profile page
    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.
    jalyc RN, Hygiene Queen, jedromey, and 8 others like this.
  4. Visit  rncat2000 profile page
    I for one would question the other BS as well, but I have also seen where if you do not let the alcohol or what ever you use to clean the finger to dry completely it will give you a high reading.
    I have seen it be off as much as 20-100 points difference on the same patient.
    But if you draw blood to verify the BS and it is close to what you are getting maybe it isn't that you are doing something wrong but those others taking it and getting lower results.
    jalyc RN likes this.
  5. Visit  LandD_RN_chica profile page
    Just a suggestion....I've seen numbers be significantly different just by wiping away the first drop of blood because it contains the alcohol etc. are you wiping away the first drop and then testing?
  6. Visit  ricksy profile page
    Thanks, guys. The last facility I did preceptorship at did not use alcohol cleanse before AT ALL. I have always did the wipe first drop..and still do...with the alcohol cleanse.
  7. Visit  chrisrn24 profile page
    Do you do a recheck immediately? Test the strips again? Also make sure you wipe the first drop and use the second.

    Also by a "lot of paperwork" what do you mean? You should only really have to write a nurses note and make an indication in the MAR correct?
    jalyc RN likes this.
  8. Visit  amoLucia profile page
    Am a dinosaur 11-7 LTC nurse. Have to use those dang little machines too. But deep down, I don't trust them. Are all the quality/test checks being done as recommended? Those monitors take such a beating because of the high usage. I switch machines when I get readings out of the ballpark, high or low.

    Funny, my problem pts are the ones who always run LOW, as in LOW LOW!
    CountyRat and canoehead like this.
  9. Visit  txredheadnurse profile page
    Quote from ricksy
    Thanks, guys. The last facility I did preceptorship at did not use alcohol cleanse before AT ALL. I have always did the wipe first drop..and still do...with the alcohol cleanse.
    If I am understanding you correctly you are wiping off the first drop with an alcohol pad? Because if you are then the entire purpose of wiping the first drop of blood off...which is to remove alcohol tainted blood so as to get an accurate reading...is being undone.

    I was always taught if glucomter results don't seem within normal parameters for the patient, recheck with a different machine at a different site and if the results are still too high/too low then proceed according to orders. I would suggest you start calibrating the machine on your cart before you start doing your fingersticks and if it is not within parameters then that machine needs to be replaced.
    Last edit by txredheadnurse on May 11, '13 : Reason: omitted a word
    SENSUALBLISSINFL, CountyRat, Esme12, and 1 other like this.
  10. Visit  ricksy profile page
    If you get a reading over 400, you must call the doctor. If you call the doctor, you must call the family. If you call the family, you fill out the paper work with their response. You must get a new order for the corrected or unpdated coverage...put it in the computer...with updated Vitals even though it is Blood Sugar...because you called the Dr....on and on and on...
    jalyc RN likes this.
  11. Visit  akulahawkRN profile page
    Wipe that 1st drop of blood away with a dry 2x2, not an alcohol pad. The practice of using an alcohol pad to wipe away that 1st drop contaminates the next drop and the glucometer will display an abnormally high reading. Try doing it the way I (and others) described and you should see "better" blood glucose levels... and they'll be far more accurate.
    CountyRat, sharpeimom, and GrnTea like this.
  12. Visit  marycarney profile page
    If it is only happening with a single patient- then the problem is not the glucometer, or your technique - IT IS THE PATIENT! Someone is either sneaking the person food, or he's got a bump from the timing of a steroid dose, or he's not getting his insulin dose at other times of the day.
    jalyc RN, LobotRN, merlee, and 2 others like this.
  13. Visit  CapeCodMermaid profile page
    Wow...either other nurses aren't really doing the glucometer checks or the resident is 'sneaking' food?!? Both of these statements are offensive. The glucometer is a machine and not infallible. Why should anyone have to sneak food? People should eat what they want as long as they know the risks of doing so. Haven't you see the latest CMS guidelines on diets in LTC? for that matter have you read the studies about managing diabetes with sliding scale insulin?
    elprup likes this.
  14. Visit  BrandonLPN profile page
    Be careful before you jump to the conclusion that the other nurses are making numbers up. It could be a million things. Maybe your technique differs. Maybe you work on days where the residents have snack filled activities. Maybe it's just a coincidence. Maybe the other nurses check later than you do and the residents have burned off more sugar by the time the other nurses check.

    Bringing this "issue" (there is no issue) to your manager would be a huge mistake.
    ricksy and Pangea Reunited like this.

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