Will they contact State Board

Nurses Medications

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My friend was fired today because she gave a patient her order of NPH insulin and held the patients Regular insulin for the AM dose. The patients blood sugar was 121, so the patient wanted Reg held. About 2hrs later the patients blood sugars dropped to 55, then to 22. So patient was given protocol treatment for low insulin. Anyways, my friend was fired over the situation, but do they call State Board and notify them of the incident? Will her license be in jeopardy of this, because our job sad she probably gave Reg instead of NPH accidentally?

Specializes in Cardiac.

Something about this post just doesn't seem right to me at all. I'm sensing some red flags here. First of all, why would she have to give regular insulin to someone with a BS of 121, usually when you give NPH the regular would be on a sliding scale and it would be held d/t the BS being 121. I agree with another poster, if this is a brittle diabetic and from what I am reading I'm going to assume it is, then the BS can drop at anytime for no reason at all. Secondly, people are mixing something up, she didn't give 12 units she gave 19 units, and I will assume she was probably very nervous when questioned and mixed patients up. If she has a lot of inmates to deal with I can see how that might have happened, especially when you are nervous. I'm not saying it would happen to me, but I'm not her, but I can see how it would happen. I'm curious when the last dose of NPH and regular insulin were given, also what time where these meds given, there are still so many questions unanswered. I can not make a judgement based on just the information given here. Anyhow, the patient in question is okay, they followed protocol and gave D5. That's why something just doesn't sound right, sounds to me like they wanted her fired. I'd get an attorney and fight this, I hope she documented this really well for her sake.

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Specializes in Pediatrics, Emergency, Trauma.

I keep coming back to this thread, for some reason :whistling:

I'm going to break down the OP's original post, and just interpret it, solely based on nursing judgement and opinion.

My friend was fired today because she gave a patient her order of NPH insulin and held the patients Regular insulin for the AM dose.

This makes me believe that the patient's order is for Regular/NPH; hence, the order could have been clarified by the provider, and the concerns of the patient should have been addressed; the use of SBAR and documentation could have addressed this.

The patients blood sugar was 121, so the patient wanted Reg held. About 2hrs later the patients blood sugars dropped to 55, then to 22. So patient was given protocol treatment for low insulin.

OK. What were the first interventions when the blood sugar dropped the first time? What was documented?

Those are my questions.

Anyways, my friend was fired over the situation, but do they call State Board and notify them of the incident? Will her license be in jeopardy of this, because our job sad she probably gave Reg instead of NPH accidentally?

What trail or supporting documents does the facility have in making this decision? If they think that she is not totally honest in her interpretation that happened, then there was cause for her being fired, unfortunately, and if they choose to report the friend to the BON, they may have a cause...they may not; it can go either way.

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The patient had the right to refuse her regular insulin, the nurse just needed to chart that. A blood sugar dropping from NPH is nothing new - and 19 units with a blood sugar of 121 is outrageously high in my opnion. I have worked under physicians that would not change the insulin dose, would not give more of a sliding scale, were adamant the patient receive the dose they ordered - well, we just flat out couldn't give that much because the patient would have died. Even holding the insulin or decreasing the amount given often resulted in critically low levels. I have diabetes and take Lantus - and patients are not supposed to 'bottom out' from Lantus. My blood sugars have gone down to the 40's a few times after taking Lantus when they were 120-130 prior to taking it. The explanation given to me was that my pancreas kicked in at the same time which caused the quick decrease. I am not sure if this is accurate but it is what I was told. Even though you don't have to eat after taking Lantus, I had eaten before or during the time I took the Lantus on each time that I dropped.

The Board of Nursing may investigate but as long as she followed policy and protocols she will be fine. If she didn't, then some remedial action may be taken but she will not lose her license as she was not negligent. In a right to work state they can fire you for any reason, and for no reason. Unless it violates your Civil Rights there is nothing you can do about it. As for future applications, if she doesn't put it then they can fire her later for having lied or omitted on her application. If she didn't work there for very long she can just leave that job off of her application and/or resume.

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Specializes in Pediatrics, Emergency, Trauma.

I wanted to also address the subsequent posts from the OP:

They just assumed maybe she gave Reg because 2hrs later BS dropped to 55.

That's possible for Regular, or a brittle diabetic...since we don't know the trends, if this was TOTALLY off the normals if this person has been under care for a period of time, I can understand the admins "assumption".

The girl was very sure she only gave NPH and held the Reg. The patient even said they were giving her too high of a dose of insulin anyways, and told the nurse, so that's why she only gave NPH and not Reg. So our supervisor said she thinks she gave Reg cause the BS dropped to quick. I believe my friend cause she knows what she's doing, but the supervisor may have it out for her. That's why I wanted to know if they can contact State Board and try to do something to her license.

She may have been sure, but a med error was committed. The steps she could have taken determines whether she will be in front of the BON or whether she has a legal standing in her favor against the employer.

Said that it was in question to why did she give the patient a snack after giving the NPH? She said because the patient told her that her BS drops all day because they give her too much insulin, so my friend told the lady that she will give NPH and a lil sandwich and an orange incase it gets low before breakfast gets there. So she was wondering can they do something to her license but they can't prove it was an error.

Ok...nursing judgement was involved. My next follow up was to collaborate with the provider in addressing the clients needs related to establishing an adjustment to the Regular/NPH insulin regimen. Did your friend make an attempt to contact the provider? Is there documentation on the incident; in notes, etc?

I think she told them she gave 12 of NPH and ordered was 19, but she did give 19, just got her patients mixed up and told them she gave 12. So I think that's why they fired her

This quote gives me all sorts of hackles...it really does. Whether it's 12, or 19, or 13...usually NPH doesn't drop the sugar so low...I've taken care of brittle diabetics where they didn't drop from NPH that fast; however, each patient is different. Then again, that is not the issue; the issue is that IF your friend mixed up the insulins, one 12, one 19, and she doesn't remember, did she let someone know immediately after??? What did your friend do after a recheck??? How long did your friend take to do a recheck? Did the patient?, who may be a brittle diabetic, need a little more monitoring before this incident? Those are my questions: the timeliness, the time period lapsing between notifying someone, those are huge factors in determining whether a person should be let go from their position and or/reported to the BON as well.

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Specializes in Pediatrics, Emergency, Trauma.

My point is, yes, the patient has a right to refuse. If she was on NPH/Regular; meaning the patient may NEED to receive Regular with NPH during each scheduled dose; so, Regular usually can be tweaked; hence me stating that the order could have been clarified and collaborated; using SBAR technique, the order could have been changed.

I see in my neck of the woods brittle diabetics do use the Regular/NPH combination because of their sugar lability. The regular is usually tweaked in instances where there is a trend of being low during morning dose and high before bedtime -I am thinking of a brittle diabetic YEARS ago that use to frustrate my healthcare team because the patient was so brittle, some doctors who would cover after hours would throw their hands up or shrug their shoulders and keep the order the same, because the patient's "pancreas is shot...nothing we can do"...until prudent assessment and documentation FINALLY allowed this person to have an insulin pump, and NPH in smaller doses did the trick. This patient was gaunt, sweaty, change in mentation, weak, just looked awful. His quality of life vastly improved once he got the insulin pump: eating, active, cognition improved.

Not everyone uses regular as SS...some diabetics have been on the Regular/NPH combo for years...if you hold the Regular in the AM, by lunch or dinner, they are HIGH, then by 3 am, they are given D50. So it's just prudent to accurately assess as best as possible; clarify orders, and document. Even get feedback from the healthcare team, no matter the personalities. It just more prudent in the long run of doing the BEST for the patient.

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This is one reason why some facilities require two nurses to verify insulin doses. I can imagine that's not easily done in a jail, though - I've never worked corrections, but I'm guessing if there's another nurse, they're on another unit.

Jails get sued all the time for healthcare stuff because the population is considered vulnerable. Firing your friend was likely a CYA move.

Also, this really sounds like one of those, "So I have this friend who..." situations where people are really asking for themselves.

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Wow, that's not cool! I was told they shouldn't contact them, and she doesn't have to put it on applications. How will she know if the board was contacted or not?

My understanding is, if the BON receives a complaint they notify the nurse by registered letter, the letter acknowledges they have received a complaint and are launching an investigation.

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Specializes in Med-Surg, Home Health, LTC.

I would not think so ..if the Board of nursing was contacted every time a med error was made, they would have

no time for anything else. We are all human and we do all make mistakes. If the hospital/facility was so unforgiving as to

terminate over situation, perhaps better all the way around. The most important thing I see here is for your friend to

reconcile within herself how she/he made this mistake and try to improve personally...figure a way to not let it happen again.

we can only learn from mistakes and become better for it.

and yes, anyone can contact the nursing board over anything, but personally I would not concern about that and rather

consider how why I made that mistake and make a system- a habit of sorts- to always do....like the 5 rights is the nurses bible.

good luck to your friend

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Specializes in LTC, Psych, M/S.

It should be a lesson for the facility as well .. ..protocol should be in place to have 2 nurses verify the insulin dose before administration.

I wonder why this poorly controlled diabetic was in jail...

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Specializes in OB/GYN.
Something about this post just doesn't seem right to me at all. I'm sensing some red flags here. First of all why would she have to give regular insulin to someone with a BS of 121, usually when you give NPH the regular would be on a sliding scale and it would be held d/t the BS being 121. I agree with another poster, if this is a brittle diabetic and from what I am reading I'm going to assume it is, then the BS can drop at anytime for no reason at all. Secondly, people are mixing something up, she didn't give 12 units she gave 19 units, and I will assume she was probably very nervous when questioned and mixed patients up. If she has a lot of inmates to deal with I can see how that might have happened, especially when you are nervous. I'm not saying it would happen to me, but I'm not her, but I can see how it would happen. I'm curious when the last dose of NPH and regular insulin were given, also what time where these meds given, there are still so many questions unanswered. I can not make a judgement based on just the information given here. Anyhow, the patient in question is okay, they followed protocol and gave D5. That's why something just doesn't sound right, sounds to me like they wanted her fired. I'd get an attorney and fight this, I hope she documented this really well for her sake.[/quote']

Yes, your right! She did give 19 of NPH, but got confused and said 12 of NPH because she wasn't looking at the MAR when questioned and was probably nervous because it was a big commotion with EMT being called in to give the D5, because the jail doesn't have IV meds. She gave the NPH at like 5:30a. She said the order was for a dose of Reg(can't remember dose), and 19 of NPH. Since the patient said her BS drops all the time because she feels like they give her too much insulin, my friend told her she can refuse the insulin if she wants or just do the NPH only. The lady said just give her the NPH only. Now since her BS drops all the time here, my friend offered to give her a sandwich and an orange incase her BS drop, and told her to call if this happens. Well she never called, and when it was time for breakfast, the lady wasn't responding. Her BS was 55. Gave her some glucose stuff we had, still no response, rechecked her BS, it was 22, called EMT, they gave D5, patient arises, and is fine.

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Specializes in OB/GYN.
I keep coming back to this thread, for some reason :whistling:

I'm going to break down the OP's original post, and just interpret it, solely based on nursing judgement and opinion.

This makes me believe that the patient's order is for Regular/NPH; hence, the order could have been clarified by the provider, and the concerns of the patient should have been addressed; the use of SBAR and documentation could have addressed this.

The 1st protocol was done by giving the patient some glucose stuff we had, and then within min we checked the BS and it dropped to 22.

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Specializes in OB/GYN.
This is one reason why some facilities require two nurses to verify insulin doses. I can imagine that's not easily done in a jail, though - I've never worked corrections, but I'm guessing if there's another nurse, they're on another unit.

Jails get sued all the time for healthcare stuff because the population is considered vulnerable. Firing your friend was likely a CYA move.

Also, this really sounds like one of those, "So I have this friend who..." situations where people are really asking for themselves.

Well thx for your thoughts, and if it were me, I would have no problems stating that! Take it how you will!

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