Insulin

[Momto2Boys]

I need verification on insulin.

If a resident has an order of 18 units of NPH at 4:30 and a sliding scale at 4:30 for regular (lets just say they needed 6 units) do you pull them up in the same needle or seperate needles?

I am a new nurse and I was taught one thing in nursing school and saw it done different in the LTC so I just wanted to double check how other nurses do this.

Thanks!

[studentque]

In a hospital facility, that is under approval by JCAHO, insulin is at the top of the list of what they call high-alert medications and requires the signature of two nurses on the med sheet, or placed in the computer if you use Accuscan or something similar. JCAHO is also spending time when they are at the facility doing their review looking for the two signatures. It has become a big thing.

And this is federal, not state. And even when I attended school, we always had someone verify the insulin dose, and that was many, many years ago. Adn it is normally taught in nursing school, and you may even see a question about it on the NCLEX exam.

In the nsg school I'm currently attending (2006), if you don't verify the insulin dose with someone else during ck-off, you will fail that ck-off. And my instructor that presented that skill stated that it is also required in the workplace. And during my clinical experience this was also a current practice by the staff.

So Suzanne, I'm pretty sure you know what you're talking about.

[LPN01112005]

When I worked LTC verification of insulin wasn't required. However, insulin (and diabetic care in general) was considered a "high risk" area of our jobs, which means we were to proceed with extreme caution in our care to these residents, especially where insulin admin. was concerned. We were very limited in using our "judgment" on these residents.

Now that I'm in the hospital, we do have to have two people to verify insulin. However, it is much easier to find someone to verify in a hospital setting because less meds are given and more nurses are on the floor. It doesn't bother me to have to get verification. I'm not immune to making mistakes just because I have a license to nurse. Insulin overdose can be deadly, which is exactly why it is on the high-alert list of meds. To be offended that you have to get verification seems arrogant to me.

[joies1]

So good to see such a discussion. I am new to this forum, so this is my first post. However, I have been an RN in acute and critical care for 20 years and insulin and heparin always required 2 signature checks [not 2 people at administration]. Believe me ~ the best and most cautious nurse can make errors!! It should not demean your license - or be taken that way.

I find myself in a different situation, now, as Health Care Coordinator on an assisted living facility. Oregon - I've heard - is on the 'avant guard' in this area. I am the only licensed person in the facility and it is my license if I don't train and delegate adequately. I have just finished a full delegation process for injecting insulin for my med aide staff. There is no way possible to have two RN signatures. And not required in such a facility. But this forum helped me recognize that I will have to substantiate and sign for each syringe I draw up for later administration by med aide. Thanks for the 'lights on'.

[seretide]

Actually what i am practising is to double check the medicines (watever it is like insulin, heparin iv antibiotics or oral drugs)before administering to a patient to avoid ANY ERROR.We just follow 5R.

[DONN]

It is slightly disconcerting reading this thread and having nurse's ask very basic questions regarding insulin,types and administration, first of all there are many many more types of insulin than are being mentioned on here. I work in acute care with cardiac and general surgery patients and believe me we administer all types of insulin so it is necessary to know the ONSET, PEAK and DURATION of each so you have a clear understanding of what and when its occuring. I suggest that if you have some real basic questions that you pull out your school books and go over things a few times to refresh your memory. Frankly its a little scary thinking that someone would relate a bottle label NPH 70/30 that this applies that you would administer 70 units. When in doubt always check your orders........

[ladybird63]

I know that at hospitals they require two signatures on insulin. They don't in nursing homes...at least no the ones I 've worked at. Both RNs and LPNs are reqired 2 signatures. That's in Fl...not sure about other states.