Co-signature for Insulin administration - page 4

by MissRN7 8,959 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
    I think it's just inefficient to have the aide check the blood sugars and the nurse to come in 10-20 min later to give the coverage. Why not just have someone (the nurse) do it all at once. Especially on night shift, it would save the pt from being woken up every hour.

    And as someone who has worked in a hospital and in LTC, I firmly believe that one of acute care's biggest failings is the lack of attention to ADLs. Pts in hospitals rarely get fed or up out of bed as much as they should. This is because the aides are too busy checking vitals, accuchecks and I's and O's. Hospitals *need* a classification of people who's sole job function is direct care. Adding all these extra duties to the "tech's" workload only seves to ensure basic care falls to the wayside.
  2. 0
    I did my practicum at a hospital that required insulin to be double checked, I now work at a hospital that doesn't. I am so happy for that! I am capable of checking my own insulin and ensuring it is correct. And like others have said, blood sugars are automatically uploaded to our computers so I know I am getting the right number. I also trust my CNAs..
  3. 0
    As others have said, our glucometers transmit the BG into the patient's chart, so there is no question it was actually done. We dual-sign insulin, but I work on a pediatric floor. The adult floors do not require dual-signing.

    I don't know - I don't mind having my insulin double-checked. It's not a big deal to me. I'd rather have someone confirm it's right than overdose a child.

    As for being the only nurse on the unit, that would never happen where I work. We are required at all times to have two RNs on the floor.
  4. 0
    Unless its up loaded directly to the computer I'd do a recheck to feel comfortable giving the insulin. Where I work (not a hospital) nurses check BS's, draw up and give all insulin. I was recently doing clinicals (for RN school) at a local hospital and my pts scheduled dose of lantus was sent up from the pharmacy already drawn up in a syringe ready to give. I felt really uncomfortable giving the lantus that someone else drew up. What if they made a mistake and filled it with Levimir or regular insulin?? That was all I could think about. I felt better when my pt refused to let me give the shot since I'm a student so my instructor gave the shot. Unbeknownst to the pt I'm an LPN and I can give a darn good shot, lol.
  5. 0
    Quote from CrazyGoonLPN
    Unless its up loaded directly to the computer I'd do a recheck to feel comfortable giving the insulin. Where I work (not a hospital) nurses check BS's, draw up and give all insulin. I was recently doing clinicals (for RN school) at a local hospital and my pts scheduled dose of lantus was sent up from the pharmacy already drawn up in a syringe ready to give. I felt really uncomfortable giving the lantus that someone else drew up. What if they made a mistake and filled it with Levimir or regular insulin?? That was all I could think about. I felt better when my pt refused to let me give the shot since I'm a student so my instructor gave the shot. Unbeknownst to the pt I'm an LPN and I can give a darn good shot, lol.
    To play devils advocate here, how do you know that the insulin in the physical bottle you normally draw it up from is what it is? It could've gotten switched at the factory, etc.
    At some point you just have to either trust it or
    Advocate for change.
  6. 0
    Frankly, I don't feel comfortable having the tech check blood sugars. It's not because they don't know how to (it's really a no brainer) but the amount of time before they can deliver the result to me.

    If the tech/CNA takes the BG for everyone in his/her round, by the time the result gets to me, it's already 30 to an hour after. Meaning, the results aren't accurate anymore.

    When I'm on the floor, I usually take BG right when the food trays come. I know that the dietary staff takes about 20 minutes to pass the first set of trays for diabetics, giving me enough time to take the BG, find a co-signer, and give the insulin. It's more accurate and it takes about 5 minutes of my time to finish the whole process.
  7. 0
    Quote from Vespertinas
    What kind of mistakes can you make with an accucheck?
    Wipe finger with alcohol, wipe dry with cotton, poke patient, wipe away first drop of blood, take second drop of blood.

    If you don't let the alcohol dry I've heard it may cause an error in the reading. I would assume the same CNA / PCT that doesn't wipe the alcohol dry is not wiping the first drop of blood away.
    ------------------------
    As a CNA, we take blood glucoses, I used to tell the RN's what it was, one of them asked to see the machine, and that's fine by me. Now I just give them the machine when i'm done checking the sugars.

    One less thing to get mixed up.
  8. 0
    Quote from turnforthenurseRN
    Where I work, the glucometers load the blood sugar result into the patient's electronic chart.
    That is SO cool! This is something that has frightened me a little because I have noticed over the years that some people (even not meaning to do so) get their numbers flipped backwards, or do something else weird with them. I'm talking people in general. Not everyone is good with numbers and I would hate to make a mistake based on something someone inadvertently transcribed incorrectly.
  9. 0
    Very interesting thread! I just started my first nursing job this week at a nursing home. When I was in school, at all of my clinical sites (which were all hospitals), techs could do BS but we did them as students on our patients. All insulin had to be co-signed all the time, and I was taught that it should always be co-signed everywhere.

    But at my new job, the nurses do their own blood sugars, and there is no co-signing at all. Having been trained to have it co-signed, I have been having my preceptor check all of my insulins, but it feels kind of weird to me not getting the co-sign.

    And something else up for debate - getting the blood sugar. I was taught alcohol swab, let it dry, prick finger, get blood. Another instructor said you should wipe away the first drop of blood, but I've heard that it can be either way - that it doesn't really matter. And another nurse told me you "don't even need to use the alcohol - just prick the finger"! This week I've been doing what I learned at school but it certainly is an interesting debate.
  10. 0
    Quote from knitnurse72
    Very interesting thread! I just started my first nursing job this week at a nursing home. When I was in school, at all of my clinical sites (which were all hospitals), techs could do BS but we did them as students on our patients. All insulin had to be co-signed all the time, and I was taught that it should always be co-signed everywhere.

    But at my new job, the nurses do their own blood sugars, and there is no co-signing at all. Having been trained to have it co-signed, I have been having my preceptor check all of my insulins, but it feels kind of weird to me not getting the co-sign.

    And something else up for debate - getting the blood sugar. I was taught alcohol swab, let it dry, prick finger, get blood. Another instructor said you should wipe away the first drop of blood, but I've heard that it can be either way - that it doesn't really matter. And another nurse told me you "don't even need to use the alcohol - just prick the finger"! This week I've been doing what I learned at school but it certainly is an interesting debate.
    I always use alcohol. You'd be surprised what people have on their hands. As for the wipe away first drop of blood, that is what I was taught but I admit if they are barely putting out a drop there's no way I'm wiping it away. I try to though.

    Do your own thing. Wiping a finger with alcohol takes an extra second.


Top