blood sugar monitoring w/o doctor's orders..

Nurses Safety

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My supervisor wants me to check my patient's blood sugar bid before his tube feedings. He is a child and I have no permission slip from parent stating it's okay, we have something from the doctor that comes around the school once a week that says we were allowed to check it once...my supervisor insists that I could lose my license for NOT checking it (her explaination: common nursing sense) ...I still do not feel comfortable checking his blood sugar without doctor orders (it has dropped to 33 before after I fed him)...but everytime I ask about it, she starts raising her voice at me and tries to tear me down...I don't know what to do...please help (links to something that says I shouldn't do it...or something that says it's okay to do it would be great...)

thanks!

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Are you a school Nurse? I work at a Hospital. We have a protocol to do Blood Sugars q6hrs with a constant tubefeeding and with intermittant feedings to do a blood sugar prior to each feeding. We don't need an order because it is protocol. Do you have protocols? I wouldn't do it unless I had an order or a protocol that said I could

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Im a school nurse...I work at a school for developmentally delayed kids...we don't have protocols for that sort of thing...when I asked for doctor's orders, my supervisor started getting upset with me and showed me a dictation from the doctor (not the child's pcp) that states we could check it that one time...his pcp doesn't believe there's a problem and won't write an order for bs checks...I just don't feel comfortable doing it at all.

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If the Doctor won't order it and you don't have a protocol giving you permission to do it and the parents have not given you permission there is no way I would do it no matter what my supervisor said. It's your license not the supervisors, But hopefully another school nurse will answer you. I work in a hospital and things may be different. Honestly I don't know for sure. But AccuChecks are invasive and not just allowed as part of nursing judgement unless there is a protocol

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Specializes in cardiac/critical care/ informatics.

I agree with Miami.

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Many times the doc only orders it once a day because the insurance co. of the pt won't pay for the extra supplies it takes to perform it more frequently. This is happening more and more with Type 2 diabetics on Medicare. I would check with your doc and see if this kids insurance/medicaid is an issue or if he has another reason. You can then document the reasoning in the record and cover your butt if the doc does not want to write orders for you to check more often.

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Specializes in Nephrology, Cardiology, ER, ICU.

My first question would be what are you going to do if the blood glucose is high or low? If you don't have a protocol in place to guide you, then why do the blood glucose? Only way I would do it is if the child is symptomatic. However, to routinely do this, especially when the parents don't know, is practicing medicine without a license.

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Can you not call the M.D. yourself? As a previous poster stated, what would you do for hypo/hyperglycemia if you don't have standing orders or protocol in place? How often do the parents check this pt. while at home? Is there a hx of problems with this pt. blood sugar flucuating? There are a lot of questions to be answered before I would do this w/o an order and permission from the pt/family. I also work in a hospital where things are a lot different, but I wouldn't take it upon myself in outpt. setting to do procedures just because a supe said so. I would work with the family and M.D. on setting up some paremeters and protocols for these situations.

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Specializes in Cardiac, ER.

This is a bit confusing,..is the pt a diabetic? You mention his blood sugar falls AFTER you feed him,.are you giving insulin? I can't believe you don't have some sort of protocol for giving tube feedings (this is tube feeding right not TPN).

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I would never do [routine] accu checks (which is what your supervisor is having you do) without a doctor's order. Your supervisor is using bullying tactics to get you to do something that requires an order. If the child's PCP or the school's physician already said No to an accu check order, then that is a No, and it should be documented in the child's record. You can still advocate for the child and call for the order again with rationale, or get a PRN order, or talk to the parents, etc.

Are all of these accu checks being documented in the child's record?

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Specializes in LTC/Rehab,Med/Surg, OB/GYN, Ortho, Neuro.

What I'm not understanding, why after his bs has already dropped after a feeding, and I'm assuming the doc knew about it, why there is not an order for bs checks. This is a potentially life threatening situation that could easily be prevented by routine checks. This kid needs someone advocating for him pronto.

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Specializes in ICU/ER.

I was under the impression that acu checks can be a nursing order/judgment. Many of times I have done an acu check(with out an order and the pt is not diabetic) if my pt LOC changes, or other symptoms appear. In fact that is one of the 1st things I check is a blood sugar..too low, have some juice please. Too high, call the MD.

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