would you be able to understand this?

[sweetieann]

Pediatric patient came in with IDDM toward the end of the night. Her insulin orders written by the PA on admission were totally unclear. Called doc on call (as by the time pt came to floor, PA had left for the night) and was told to call peds endocrine. I work at a psychiatric hospital, and endocrine docs at the affiliated children's hospital are pretty bare-bones at night time, so they wee unable to actually come over and see her that night. Paged the endocrine docs and they did call back and gave verbal order: "Discontinue all insulin and protocol orders. For tonight into tommorrow morning, check FSBS at 12am, 3am, and 7:30 am. Call children's hospital with before meal glucose and how to proceed."

Now, this all made sense to me, as the protocol orders that come with the patient have only have the RN checking the pt's glucose at 3am and a few other things not really applicable at the time. The peds doc basically said that in the morning, peds endocrine could decide how to oder the insulin once they knew how the patient's diet orders would be etc and once they knew her over night blood sugars. If they wanted to reorder the ptocol, they could do that too.

Just wondered: does that verbal order make sense to you guys too? Some nurses were confused and seemed to think we were to call with EACH before meal glucose endocrine. The way I interpretted it was [since it says tonight into tommorrow morning ] was to call over there in the morning and basically say "look we have no orders, what do you guys want us to do?" To get slidign scale orders, orders to cover meals, any night-time insulin, etc... Really ,endocrine should come see her anyway...it's psych, but it's still a hospital.

Thanks for any thoughts!

[ChristineN, BSN, RN]

Just wondered: does that verbal order make sense to you guys too? Some nurses were confused and seemed to think we were to call with EACH before meal glucose endocrine. The way I interpretted it was [since it says tonight into tommorrow morning ] was to call over there in the morning and basically say "look we have no orders, what do you guys want us to do?" To get slidign scale orders, orders to cover meals, any night-time insulin, etc... Really ,endocrine should come see her anyway...it's psych, but it's still a hospital.

Thanks for any thoughts!

Hey, I work peds endocrine, and we call the edocrine before each meal and snack for dosing. We don't use a sliding scale like adult facilities do. Instead, once they find out the blood sugar, they give us an oder for insulin (usually Lispro). It does take alot longer to wait this way. Also, even if you are a psych hospital, you should probably find out if the pt carb counts or not, so that can be figured into her insulin dosing.

[sweetieann]

thanks! that makes much more sense since peds pts are so fragile, I wish ours worked that way.