Co-signature for Insulin administration - page 5

by MissRN7

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


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    Quote from PediLove2147
    Do your own thing. Wiping a finger with alcohol takes an extra second.
    It dries out the skin. Soap and water is what we do. (It's what people do at home.)
    But as always, follow your facility's P&P.
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    Interesting, I was taught that it's unnecessary to wipe away that first drop. I also find the double check odd. I understand the need for caution, but I can push narcs all night long without anyone ever double checking. We also have to have our
    SQ heparin, which is only ordered in 5000 unit per 1 mL doses (and only comes in vials with the same concentration) double checked, yet we can hang a heparin drip without a co signature. It's just silly.
    Vespertinas likes this.
  3. 1
    Quote from Aurora77
    We also have to have our SQ heparin, which is only ordered in 5000 unit per 1 mL doses (and only comes in vials with the same concentration) double checked, yet we can hang a heparin drip without a co signature. It's just silly.
    Ours is opposite. We can give SQ heparin without a co-sign but IV requires another RN. I give SQ heparin to 4/5 of my patients 2x during my shift, a co-sign would be torture!

    Alcohol does dry the skin but sometimes washing a patients hands isn't always feasible. Clean them with something, anything is what I was getting at.
    PatchycatRN likes this.
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    At my facility, the BG is uploaded to the EMR, so I don't worry about the tech making up numbers. I'm not going to stick a pt that has already had 5 finger sticks in five hours just out of paranoia. I always look and check to see how their BG levels have been trending, so if something is off, I'll see it. I work in the ER, so there is always someone around to verify any insulin I have to give. I think it's a little pointless, as half the time when I'm administering insulin I'm going off of a verbal order, but it's not a big deal.
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    Turnforthenurse-we are looking at implementing equipment and interfaces that would auto-populate BS into the electronic system. What kind? Brand of glucometers do you have? Also does anyone know what automatic Bo units in pt rooms are a good price, nice system and you can get interfaces to populate data, such as BP, pulse resp, pulse of ECG ??
  6. 0
    Quote from blackvans1234
    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.
    Why would you assume that one practice automatically means the CNA is doing another? Besides, if you're wiping away the first drop, aren't you in effect removing the alcohol at the same time?

    Also, I'm on my phone so I can't search for it now but I posted maybe a year back a study that showed no statistical difference in blood glucose readings between the first and second drops of blood.
  7. 0
    Quote from Vespertinas
    Why would you assume that one practice automatically means the CNA is doing another? Besides, if you're wiping away the first drop, aren't you in effect removing the alcohol at the same time?

    Also, I'm on my phone so I can't search for it now but I posted maybe a year back a study that showed no statistical difference in blood glucose readings between the first and second drops of blood.
    I remember reading a piece in a journal (Nursing 2010 or the like) a few yrs ago that said the recommendation now it to let the alcohol dry and not wipe away the first drop. The point was, the alcohol had to dry.
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    My facility just went to co-signing for insulin, which is a pain. If I don't hold the syringe out to the 2nd nurse, they almost never actually look at the dose, but just sign off in the computer. Apparently the decision to go to this was due to a med error on another floor where the wrong insulin was given. To me, that just indicates that the nurse was not scanning her meds before administering or else the computer would have popped up a message (unless perhaps they were giving two types & mixed up the doses for a pts Humalog vs Lantus? YIKES).
  9. 0
    Quote from psu_213
    I remember reading a piece in a journal (Nursing 2010 or the like) a few yrs ago that said the recommendation now it to let the alcohol dry and not wipe away the first drop. The point was, the alcohol had to dry.
    The problem is that we're aware of these new recommendations but we still are bound to hospital policy. So unless you're on a council that can effect that change, just stick with policy folks.


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