2 Nurses needed??? - page 3

We are having a "dispute" of sorts at our small hospital. For the longest time, we have not had a policy that 2 nurses had to verify amount/type of drawn up Insulin and Heparin. Many people think... Read More

  1. by   AHarri66
    Originally posted by CougRN
    Give me a break. If you don't have the sense to know that 40 units of insulin isn't a regular dose and you should check the order then you aren't paying attention.
    Gee...I've had patients on 40 units of NPH before, nothing unusual about that.

    Also, we had an incident not too long ago where the order was transcibed in such a way that the "U" for units looked like a "0" in "40". It spurred changes in our transcription protocol, as well as in the way MDs are required to write the order.

    Our policy requires double-checking insulin and heparin, also, both gtt and sq. We only have to sign off on the heparin gtt. We double sign off on PCAs and epidurals as well.

    Personally, whenever I give IV digoxin (or any other IV cardiac med), I have another nurse check my calculations just because. No one is perfect, even nurses, and my patients' safety is far more important than my ego.
  2. by   emily_mom
    Originally posted by CougRN
    Give me a break. If you don't have the sense to know that 40 units of insulin isn't a regular dose and you should check the order then you aren't paying attention. I do agree that having certain gtt rates checked with peers is a good idea. But come on now, do you really need someone to check your insulin dosage before you give it? If it is out of the ordinary then yes, check the order. But a normal dose of insulin you should be able to handle yourself. If you are in such a hurry to get home and don't stop to think about your patient then I hope I don't have to work with you. We all need to focus on our jobs and really think about what we are giving our patients. You shouldn't have to have someone else always checking your dosage. We are smart enough to know what is normal and what should be rechecked.

    Simmer down. My God.

    It IS protocol at my facility (and the two before that), and we all abide by it. What is the difference of 15 seconds to prevent a serious med error? Some nurses don't have the best sight, and the syringes are small. I've caught a few near misses because the RN/LPN drew it up wrong. It happens.

  3. by   surgorthonurse
    Old school or not...Is 10,000 units of heparin or 2 units of insulin worth throwing your career away for???
    If so I hear Burger King is hiring...
  4. by   emily_mom
    I'll have a Whopper with no pickles please....
  5. by   New CCU RN
    We also always double check any heparin boluses, or sub q hep or insulin. For some reason, we don't check insulin gtts.

    Anyhow, these aren't the only meds that i will often check with another nurse. Every nurse is a person and we are all gonna make a mistake. If you honestly think that you will never make one, it leaves me to believe
    1) you are not a nurse yet, but a student, and you haven't been working out there yet
    2) you are a nurse but you are one scary nurse, who is gonna make an even bigger mistake then the double checkers out there.
    When you need someone to back you for whatever reason, and Coug your day will come.... I'd rather have someone else on my unit being able to verify that yes I did give x amount of a drug.
  6. by   New CCU RN
    Oh.... and i have also had patients get up to 50 u of NPH... not all that uncommon... and not so hard to pick up a different insulin bottle by mistake....
  7. by   kimmicoobug
    Here in town, both hospitals also require a second set of eyes, though it is not required you co-sign.
  8. by   CougRN
    So NewCCU i have seen you on the CRNA board many times. So when you become a CRNA are you going to ask the circulator if you are giving the correct dose of Sux or Diprivan? I'm not saying I never ask for help because I do. But I also now how to do my 5 rights before I give any medication. I don't need a policy to tell me that before I give a med I should make sure I'm giving the right one at the right dose and so on. Think what you want about my skills but I am a very competent nurse and I know when to ask for help. But not every time I give a drug.

    I have asked around my facility because I really thought this was odd. It is required on the floors, med/surg and so on, but not in the ICU's. Maybe it has to do with having a number of patients and trying to keep everything straight. I'm sorry but I had never heard of this and really thought it was strange. But no, i'm not a student and i'm not a scary nurse.
  9. by   luvbeinganurse
    At my hospital, we double check insulin and blood products. Both nurses sign off on the blood products, but not the insulin. There is no rule to double check heparin, but personally I think it's a great one - wish it was one.
  10. by   TNcanNURSE
    I have never worked anywhere that SUBQ heparin or insulin had to be double checked. We do have to be double checked on those meds if they are being given IV, but not SUBQ.

    40 U may not be typical, but I have one patient whose dosage is in the mid 70's in the am, but then again she is noncompliant with her diet and is frequently seen downing sweets and Pepsi.
    Her dosage is probably too high. On the rare occasion that she doesn't ingest massive quantities of sugar her accuchecks fall into the 20's. Personally I think they could lower her dose and change her BID accucheks with SSI to something more frequent. Things being as they are, she has to be watched like a hawk.
    Last edit by TNcanNURSE on Mar 21, '03
  11. by   JnJTyson
    Wow. OK..I am a student in LPN school right now. And I do not have the attitude that I'll never make a mistake. They happen...hopefully it won't be a mistake that could have been prevented by 15 seconds of double-checking.

    I worked at a Urology office for a brief period of time. I did not stay there because I was uncomfortable due to lack of training. They hired me as an "MA" But I'm only a CNA at this time. When asked about blood draws and injections, the nurses just said "You take the needle, put it in and get the blood..not that hard." I just wasn't OK with that. And then my mistake came...Thank (insert higher power name here) that it wasn't a patient mistake. (I have to be PC these days..lol)

    I forget the actual name of the drug now, but its for prostate cancer patients. Its given every few months IM. Its a pickey drug. Medicare won't pay for it if you give the injection 1 day before its due...and it costs like 1500 bucks each time.

    Well, there I was with this bottle that had to be mixed before giving the injection. What did I do?? I sprayed 1500 dollars worth of medicine all over the floor. Why? Because no one took the time to SHOW me how to do it correctly. They just say "you do that, mix that and go."

    So..my mistake in not actively searching out help, giving up, and trying to figure it out myself ended up in money lost. Tought me my lesson when it comes to asking for help.

    I loved the job...but realized I needed more education to feel comfortable doing it....but I will ALWAYS double check when it comes to things I'm not 100% sure of...and as a student nurse...I'm trying to make habits out of double checking....

    So...hopefully I won't end up in front of the Board of Nursing during my career trying to defend a dumb mistake that could have been avoided!! =0)

    Jules
  12. by   BrandieRNq
    TNJ...Lupron?
  13. by   AHarri66
    Originally posted by CougRN
    So NewCCU i have seen you on the CRNA board many times. So when you become a CRNA are you going to ask the circulator if you are giving the correct dose of Sux or Diprivan? I'm not saying I never ask for help because I do. But I also now how to do my 5 rights before I give any medication. I don't need a policy to tell me that before I give a med I should make sure I'm giving the right one at the right dose and so on. Think what you want about my skills but I am a very competent nurse and I know when to ask for help. But not every time I give a drug.

    I have asked around my facility because I really thought this was odd. It is required on the floors, med/surg and so on, but not in the ICU's. Maybe it has to do with having a number of patients and trying to keep everything straight. I'm sorry but I had never heard of this and really thought it was strange. But no, i'm not a student and i'm not a scary nurse.
    Coug, you obviously don't read things very closely, because this thread wasn't about every time a drug is given, it's about whether a hospital has a policy for double-checking certain drugs. Your inability to read something this simple could very easily translate over to a drug error.

    Did you ever think that hospital policies are written because of research done into the causes of med errors??? Or is it because all of us other nurses out here are just not as smart or competent as you, and we never learned our 5 Rights???

    Last edit by canoehead on Mar 21, '03

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