Co-signature for Insulin administration - page 2

by MissRN7 8,838 Views | 48 Comments

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 and just write a random... Read More


  1. 0
    Quote from sapphire18
    A little off-topic, but I have never heard of "CBS" until I came to this site- what does the "C" stand for?
    I'm not familiar with it either. Perhaps capillary blood sugar?
  2. 2
    Yes, capillary blood glucose.

    In several facilities I've worked, not only did we not not co-sign for insulin but we also adjusted the doses ourselves based on various factors and just updated the practitioners. Co-workers at another hospital nearly fell over when I told them that one.

    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.
    DroogieRN and sapphire18 like this.
  3. 1
    Quote from Vespertinas
    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 tend to agree. I worked at a facility where we had to get another RN to cosign our coumadin doses before we gave them...even more silly!
    Vespertinas likes this.
  4. 0
    There 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.
  5. 3
    ugh, 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.
    JZ_RN, sapphire18, and Vespertinas like this.
  6. 1
    I 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....
    sapphire18 likes this.
  7. 0
    As 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..
  8. 0
    "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.
  9. 0
    What 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)
    Correct dose
    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."
  10. 0
    Until 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.


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