Accuchecks

[webbiedebbie]

Who does them at your hospital? Our lab techs have to draw them. I get frustrated because they are not drawn when they are supposed to be.

Also, when are you supposed to use a new bottle of insulin? Do you go by the expiration date on the bottle or 30 days from the time it was opened and first used.

[bargainhound, RN]

State Board of Nursing determines who can do the fingerstick blood sugar tests. Hospital policy takes it from there.

Hospital policy determines how long you used insulin bottles...some go by the date on the bottle and some have 30 day policies.

[purplemania, BSN, RN]

Insulin bottles should be discarded within 30 days of opening or expiration date on bottle: whichever comes FIRST. Actually, some manufacturers are saying the medication is good longer than 30 days so you might want to check with them.

Licensed and unlicensed personnel do bedside glucose checks here, depending on other duties, patient acuity. Most units have a greaseboard in the med room with room numbers in one column and times across the top, creating a grid. Whoever does the BS must write in the result at the appropriate time. Of course, the nurse can check the memory of the glucometer to see if a patient's sugar was checked. It is always the nurses's responsibility, so I would make sure it gets done then write up the CNA or Tech if they are not doing a delegated task.

[bargainhound, RN]

Oklahoma currently only allows licenses personnel to do fingersticks....LPN or RN...CNA are not allowed to do these currently by state board rules.

[RNKPCE]

Our CNA s usually do them or we do the fingersticks.

Our insulin has no expiration(other than manufacturers) if refridgerated. If not refridgerated it is 30 days from when it was opened as long as not past manufactures expiration. This is a recent change in the last couple of years.

[IamRN]

I'm in TX and licensed and unlicensed personnel can do them. I have to admit, I do all my own because somehow it doesn't feel right giving medication on someone else's say so...

[MiaLyse, APRN]

I agree. I would definitely feel uncomfortable administering insulin when someone else got the BS level.

Kelly

[babynurselsa, RN]

Originally posted by bargainhound

Oklahoma currently only allows licenses personnel to do fingersticks....LPN or RN...CNA are not allowed to do these currently by state board rules.

I got a little worried when you said this since every facility I have ever worked at has permitted our pct staff to do accuchecks. I went to the OBN website and looked at the skills allowed to be performed by advanced unlicensed assistantsGeneral Information

The Board-certified Advanced Unlicensed Assistant (AUA) is qualified to perform the skills included on the approved skills list in an acute care setting, provided that:

1. the skill is included in the employee's job description; and

2. a licensed nurse has made an assessment and determined it is safe and appropriate to delegate the task to an AUA.

It is expected that AUAs will know their personal, legal and ethical responsibilities and will work within the limits of their training and job description.

Approved Skills List

Basic Diagnostic Testing

1. Perform blood glucose monitoring*

a. Finger/heel sticks

b. Bedside glucometer

2. Perform Electrocardiogram (12-lead EKG)*

3. Apply & discontinue telemetry monitor*

4. Perform doppler*

Sterile Specimen Collection

1. Obtain uncontaminated blood specimen by venipuncture syringe or vacutainer with collection in correct tubes**

2. Obtain uncontaminated urine specimen from indwelling/straight catheter

3. Obtain uncontaminated sputum specimen

4. Obtain specimens of wound drainage

Asepsis

1. Medical asepsis***

a. Correct handwashing technique

b. Demonstrate universal (standard) precautions

All unlicensed personnel will demonstrate correct medical asepsis.

2. Surgical asepsis

a. Create sterile field

b. Apply sterile gloves

c. Don sterile gown

d. Open sterile packages

e. Remove sutures, staples and/or drains

f. Apply sterile dressings

g. Perform other sterile procedures as assigned

Airway Management

1. Oral Suctioning

2. Provide stoma care for patients with chronic tracheostomies

3. Assist with incentive spirometry

Elimination

1. Urinary

a. Insert indwelling/straight catheter

b. Irrigate indwelling catheter

c. Remove indwelling catheter

2. Bowel

a. Perform stomal irrigation

b. Apply colostomy/ileostomy pouch***

c. Skin care***

Nutrition

1. Administer enteral feeding through established tubes

a. Nasogastric

b. Gastrostomy

2. Irrigate feeding tube

Restraints

1. Apply limb & vest restraints, safety belt****

2. Monitor placement of restraints****

*May be performed by non-Board certified unlicensed assistants if the employing facility has provided and documented "adequate, specific training and orientation to perform the tests, and demonstrate satisfactory levels of competence". (Joint Commission Standard PE.1.12)

This made me feel better. I thought it would be insane for all of the facilities I have ever worked at to be violating the standards.

[austin heart, BSN, RN]

Our nurse techs usually do our fingersticks, unless they are busy, and then we do them. I trust all our techs. But, our accucheck machines also have a feature that you can go back in and look at a patients results by entering their med record #. I do this often if a result is unusually high.

We don't have phlebotomists at our hospital so the techs also do the majority of our lab draws, unless the patient has a line, then the RN must draw it.

By the way webbiedebbie, what hospital are you at. Just curious....Maybe we know each other.

[zacarias, ASN, RN]

At my hospital, only RNs (no LPNs employed here) are able to do accuchecks which is kind of annoying since depending on how many you have to do, it can take up a lot of time. Plus I hate serially poking people.

[grdmdb]

do you have to wear gloves to do the finger stick testing?

[getoverit, BSN, RN, EMT-P]

It is a policy that you are supposed to observe universal precautions everytime you perform a finger stick. Does my manager yell at me if I don't have gloves on occasion?...no. Do I wear them all the time?.....no. Have I ever needed them and not had them?.....also, no.

It's different in the back of a helicopter that's shaking and swaying, you may accidentally stick yourself but on solid ground in the ICU, the odds are in your favor. That being said, I certainly am not advocating any lapse in the observation of standard universal precautions.