I am a night charge nurse that works in diabetic research. Two nights ago I was given shift report about a subject with a low blood sugar. Well come to find out the evening nurse had allowed the subject to administered 35 units of Humalog with a BS of 108, post dinner. At the time for HS snack the subject was down to 56 and symptomatic. Administered the snack right away, and continued to monitor his BS Q15mins until symptoms subsided. The subject continued to be on a roller coaster with his BS's and finally at HS he was 52 and I suggested to the nurse assigned that he should obtained fingersticks at his discretion and administer OJ and crackers before bed. Then came the big question....should I administer the 30 units of Lantus? I advised no. The subject was obviously unstable and I wanted to avoid any more dips in his BS. We should wait until morning and see what the doctors would like to do with his regimen of insulin. So the nurse held the Lantus, and agreed to report to the day nurses to notify the doctors in the morning. 0200 the subject was back up to 78,asymptomatic. The next morning the day nurse failed to notify the doctor, and the doctor found out the hard way about the Lantus being held the night before. The doctor had a hissy fit! And these are the new rules that came from the Doctor's hissy fit...
Now if a nurse is going to hold any medication....we have to obtain a doctor's order. Now if the subject wants to administer any more or less insulin than what is written in their medication history....we must obtain an order.
Nurse's discretion is somewhat of a gray area, but it falls under the oath of patient safety. I know in a hospital setting I held insulin all the time for low BS, also B/P meds, without an order. I'm just wondering if I used my nursing discretion correctly? I know Lantus peaks in 6 hours (and good thing the subject didn't get lantus, b/c he was down in the 40's in the AM), but I am monitoring subject safety. And I thought that was the safest thing to do within my scope of practice for that particular study.
The doctors do not want to be notified in the middle of the night unless the subject is symptomatic, or if it's an emergency. But its such a catch 22 sometimes! The doctors get mad b/c my night nurses don't call them, but whenever we call we get rude answers and attitudes. Plus the questioning of why it couldn't wait until morning. Sometimes I feel like I never make the right decision, and my nursing discretion sucks....
These new rules about obtaining an order for holding medications are irrational. Do nurses need to have the hands held so much or am I feeling belittled?
Anyways, thx for letting me vent.
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