administering meds during emergencies without a standing PRN order

vanburbian · Sep 7, 2011

What does YOUR place of employments policy state?

Mine could be different than yours.

patrickrlim · Sep 7, 2011

we dont have a policy in place with this. i work at a dialysis unit wherein our standing PRN orders just basically carry saline and 02. Even clonidine isnt PRN.

Anna Flaxis, BSN, RN · Sep 7, 2011

Your facility should have a hypoglycemia protocol in place that can be initiated by an RN when a patient is hypoglycemic.

In the absence of such a protocol, then technically, yes, you do need to get a doctor's order to give D50. However, I cannot imagine a doctor on this planet having a problem with a nurse pushing an amp of D50 on a patient with a CBG of 21, and giving them the order in retrospect. What if it takes 30 minutes for the doctor to return your page? You can't just wait around while your patient slips into a coma.

DabearsDitka · Sep 7, 2011

If the patient was alert enough to drink OJ I think you made the right decision. Obviously you monitor to make sure the BS goes up appropriatley otherwise you could have given your patient glucose gel 15-30 grams. IV 1 amp of D50% (25 grams of dextrose in an amp) If patient has no IV you can give glucagon sub Q (not the gel kind you have to reconsitute the powder in sterile water) If they we're unresponsive on the floor call in RRT/CODE blue and give D50 ASAP. Again if they we're alert enough I would have waited to see if giving the patient enough simple carbs would have done the trick. A BS of 21 is awfully low. I'm going off the information you've provided though. In an emergency situation any ACLS certified individual is expected think of H's and T's and hypoglcymia is one of those. Check your hospitals policy. At mine I work in the MICU and we can override and give those med's while waiting for an MD to show up, we can decide to defriblate or cardiovert based upon on interpretation of the rhythm. Make sure you have a good strip of the rhythm before so you don't have anybody questioning after the fact. Our floor nurses can not do this even if ACLS ceritified they can only use the AED mode on our defib. Hope this helps.

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Sep 7, 2011

The important point is that the patient was able to take the OJ by mouth. Sounds like D50W wasn't needed. Good job.

There are no meds a nurse can give without direct or standing orders. You put your license on the line by doing so. That said, many times I've given D50W, Narcan, defibrilated patients, and on and on to end an immediate life threatening emergency. Yes, I put my license in jeopardy each time, but believed a life was more important, and when working on EMS I quickly learned that it's always easy to justify doing what's needed in the patients best interest. Rules are nice, but they can't cover every contingency.

Jenni811, RN · Sep 7, 2011

i called an MRT on my patient with a blood sugar of 28. she went unresponsive, so it was a must.

honestly though, if a patient is ordered insulin there should be a PRN for dextrose.

RN58186 · Sep 7, 2011

I had the same situation on a night shift a number of years back. We had a pt seizing because her blood glucose was so low. (Less than 1.0 mmol/L.) I paged the doctor then got the D50 ready (we weren't allowed to push it but we would mix it in a minibag and run it wide open). Long story short, I ended up paging our doctor 7 times before he returned my page. In the meantime I had paged the on call senior medical resident, who couldn't come but sent the ICU resident. While all this was going on I gave the D50 and just as the ICU resident arrrived our doc phoned back. The ICU resident assessed the pt, and spoke to our doctor and told him that "It's a good thing you have good nurses because your nurses saved her." The doctor on called thanked me for saving his butt and gave me an order for D50 PRN. And he learned to return pages promptly...

patrickrlim · Sep 7, 2011

The important point is that the patient was able to take the OJ by mouth. Sounds like D50W wasn't needed. Good job.
There are no meds a nurse can give without direct or standing orders. You put your license on the line by doing so. That said, many times I've given D50W, Narcan, defibrilated patients, and on and on to end an immediate life threatening emergency. Yes, I put my license in jeopardy each time, but believed a life was more important, and when working on EMS I quickly learned that it's always easy to justify doing what's needed in the patients best interest. Rules are nice, but they can't cover every contingency.

- well said! then again, would the board of nursing see it that way? I dont have any problems giving the D50, i would do it in a heartbeat. But then again, practicing medicine as a nurse is grounds for revocation of license

dthfytr, ADN, LPN, RN, EMT-B, EMT-I · Sep 7, 2011

I'll sell shrimp out of a roadside van if I have to. Everytime I put myself on the line I think of that. Life if too precious and fleeting, and I couldn't live with myself knowing I let someone die unnecessarily because I was afraid for my license. I could hold my head high and look the board of nursing straight in the eye if they're going to tell me a person has to die because of their rules.

I'd never tell another nurse to take that chance. That's a decision each nurse has to make for themselves. It's safer to obey all the rules and laws.

Isabelle49 · Sep 7, 2011

- well said! then again, would the board of nursing see it that way? I dont have any problems giving the D50, i would do it in a heartbeat. But then again, practicing medicine as a nurse is grounds for revocation of license

I think the BON would do exactly as you stated. Their business is to protect the public, not support nurses!

Anna Flaxis, BSN, RN · Sep 7, 2011

I'll sell shrimp out of a roadside van if I have to. Everytime I put myself on the line I think of that. Life if too precious and fleeting, and I couldn't live with myself knowing I let someone die unnecessarily because I was afraid for my license. I could hold my head high and look the board of nursing straight in the eye if they're going to tell me a person has to die because of their rules.
I'd never tell another nurse to take that chance. That's a decision each nurse has to make for themselves. It's safer to obey all the rules and laws.

Well said.:redbeathe