Co-signature for Insulin administration - page 2
Hi All!! I am a new RN and hope to get job at a hospital or nursing rehab so I can build my nursing skills and confidence. I have heard rumors that some cna/pca dont check blood surgar of pts... Read More
Apr 14, '12There are no med aides in my state. I did not know of two signatures for insulin administration until I read about it here. Frankly, I think it is not a bad idea, in theory. With the number of residents for each nurse to deal with for insulin administration, it would have been very impractical in the facilities where I worked.
Apr 16, '12ugh, I think one of my most hated policies. I know there has to be a sentinel event that triggered this event somewhere, but its really not conducive to timely patient care to find another RN to double check my insulin with each dose adjustment. And with insulin drips with Q 1 hour (sometimes Q 30 minute) adjustments that lock the computer charting system until another RN can verify/chart they indeed double checked the insulin dose. Its a Major PIA and frankly takes away from patient care. 24 + dose adjustments a day are more than excessively time consuming with the extra checks. Why with our license can I adjust propofol, versed, ativan, etc.... that can surely kill you a lot faster (and more often you would probably think) without having to use another RN to cosign.
If 2 RN's are truly needed for safe patient care I would definitely have more time on my hands at work and all these new grads would have all kinds of work.
Apr 16, '12I think it's funny they trust me to draw up morphine and administer that accurately, but not insulin...
When I worked as the only licensed person on a med-surg unit, I had to go back to the ER and leave my patients without a licensed person just to double check insulins... I think it would have been more safe for me to triple check my insulins then to have to leave the unit completely....
May 2, '12As the only nurse on my floor I do all my own BG checks with a machine that doesn't keep record, better write it down. No one checks my insulin, but after drawing it up, I leave the vial I am using out then check the mar and the syringe before administering it.. no errors so far. I can read and do simple math..
Feb 5, '13"I can't stand having my insulin double-checked. It's a waste of my time and insulting my intelligence. I mean, honestly how many RNs does it take to screw in a light bulb? Besides, this facility just makes us get the signature but probably 75% of the RNs don't *actually* double-check."
I dont think measures to ensure patient safety should make anyone feel like their intelligence is being questioned, if you feel that way thank god I am not your pt. I am new RN on orientation on my 3rd week, and a couple of days ago I had a CNA report to me the BS of my pt's roommate, who was not my pt. When I asked her at dinnertime what his BG was, she says " I dont have orders to take his BS". I said " what do you mean you gave me his lunchtime BS?" and that is when I found out it was actually the roommates.I felt the most horrific sense of dread at that moment that I have never felt in my life. I rechecked his BS right then and it was in the 80's, thank god. I was never taught that it was the hospital policy to use the reading from the EMR only, I trusted the CNA. We did not know why his BS wasnt uploading, and she told me she confirmed in the glucometer that it was 200. I should have seen it with my own eyes or retested it myself if I had doubts. I gave 4 units of regular insulin and that dose was verified electronically by my preceptor. I feel angry at myself and the breakdown in communication that lead to that potentially fatal error. For some reason, she did not receive in her report that he was an accucheck. She did not check in with me before the beginning of the shift and i did not check in with her. I hope that someone reads this and learns from my mistake before something like this happens to someone else and it does not turn out well. Some hospitals do not allow CNAs to do accuchecks and now I see why, from now on I think I would feel more comfortable doing them myself. I am still awaiting being talked to by my nurse manager about this situation and I am not looking forward to it.
Feb 6, '13What does your facility require as far as insulin double-checking? There are many points during which a medication error can occur, as there are for ANY medication.
Actual blood glucose result as verified by computer upload
Correct patient on whom you are checking blood glucose
Determine accurate insulin dose by checking personalized sliding scale
Correct medication (type of insulin)
Non expired medication (I've had a nurse make me re-draw after identifying that the bottle was unmarked...annoying but fair)
Administering to correct patient
Do you have to do all those? I doubt it. My facility has us just check that we're drawing up the right dose and right drug. I find this a waste of time because we're already scanning the barcode so it's definitely the right drug. I find it insulting because if you can't click a pen to the right number or draw up a vial accurately, then we have bigger problems.
If we're so worried about things like these, why don't we also have double-checks for say, coumadin administration? The nurse should be checking the INR before administration but can we really trust him/her to do that alone? Are we sure that they're even giving coumadin to the right patient? We should have someone double-check these things!
edit: psu_213 actually mentioned this happens! I must have totally forgotten and it subconsciously re-surfaced
Two more things: the last post on this thread was May of '12... kinda old. But thanks for bringing me back to AN, I miss being snarky to strangers. And the old favorite: I love hearing nurses who are on their 3rd week of orientation make grand statements like "I wouldn't want you to be my nurse."
Feb 7, '13Until coming on here I didn't know anyone other than nurses did blood sugar checks! Even as nursing students we weren't allowed to check blood sugar. I agree that sometimes the nurse double check seems silly, but I don't know that I would ever feel comfortable giving insulin without checking the sugars myself.
Feb 7, '13I'm not sure I undestand the rationale why some nurses say they don't feel comfortable with a tech checking blood glucose. Can someone explain that again?<BR><BR>I promise I won't respond rudely.
Feb 7, '13Quote from VespertinasI would just feel more comfortable giving insulin having done the check myself. We all make mistakes cause we're human and with someone else doing the accucheck there's a larger area for a mistake. That's just me.I'm not sure I undestand the rationale why some nurses say they don't feel comfortable with a tech checking blood glucose. Can someone explain that again?<BR><BR>I promise I won't respond rudely.
Feb 7, '13Our pts are scanned when their bs is checked so i just have to wait until its downloaded into the system. Plus our pts usually know what their bs was and when it was checked and I always check with the pt. I think it's stupid to have a double check on insulin, that's hardly the most deadly drug I give in a day, but you gotta follow rules.
Feb 7, '13Quote from VespertinasDoing the blood sugar on the wrong pt, as mentioned earlier in this thread, telling the nurse the wrong number, especially if you're doing a lot of checks at once. I've always done the check, grabbed the insulin and given it. It's just like if someone were to verbally tell me a lab result and expected me to give possibly dangerous meds because of that lab, I would want to check it first to make sure.What kind of mistakes can you make with an accucheck?
Feb 8, '13Quote from SionainnRNThat's what I'm driving at. I don't know about your facility but I am required by policy to check the computer and verify a blood glucose before giving insulin. If they don't upload automatically I'd check the glucometer and verify by MRN. Even that takes less time than doing the blood sugars yourself.It's just like if someone were to verbally tell me a lab result and expected me to give possibly dangerous meds because of that lab, I would want to check it first to make sure.
Like you said, you'd double check all your values before implementing a possibly harmful intervention. That kind of mistake (wrong value or wrong pt) can happen for any number of scenarios. Wrong BP, given BP medication. Wrong blood draw, electrolytes repleted. Wrong urine output, fluid bolus given. Wrong weight, diuretic not prescribed. Wrong temperature, fever workup done on wrong patient. I don't think that means we should strip techs of their right to do those things.
My point is that there should come a point where we can trust that our techs are competent at their skills but at the same time employ the techniques of multi-level checks that we've been trained to use for the purposes of patient safety. We all can make mistakes but that's why in healthcare we try to have a lot of checkpoints where they can be corrected. Sure, it creates a longer chain of command but that drawback is totally worth it for the benefits of teamwork which ultimately save you time to do OTHER RN interventions instead of getting fingersticks on all your patients.