Blood Glucose Monitoring

[Tweety, BSN, RN]

Prompted by another thread, I was wondering about accuchecks.

A while back our a pharmacy/nursing committee asked that all accuchecks be done by the day shift 30 minutes prior to breakfast and sliding scale and/or daily insulin doses be given then.

This was so extremely difficult, as nurses were barely able to get out of report by then, as well as they CNA's were busy doing vital signs, etc. Most of our units have slowly gone back to the night shift doing them.

Sometimes when there is only one CNA on the floor, this CNA must do several accuchecks and have them charted, along with I&O's, vital signs, etc. they sometimes start early, usually around 6AM or earlier.

On our floor our manager wants us to go ahead and give sliding scale coverage and let the day shift give any regularly scheduled insulin. (If there are both, the day shift is to give them.) If I was a dayshift nurse I'm not sure how I would feel giving insulin based on the previous shift's accucheck which might have been about 2 hours prior.

So far we haven't had any problems. But this doesn't seem ideal and I doubt the state board would be supportive should a nurse get into trouble.

What does your facility do?

[ayemmeff]

Our night shift does the accuchecks at about 7am, insulin is given at around 8ish, breakfast arrives at 8:45(way too late IMHO).

I,m personally happy to rely on the nightshift's results,UNLESS the patient has unstable blood sugars in the past 24 hours or so,then i do my own check for peace of mind.

[nakitamoon]

Dealt with same problem here,,,,

Best solution for us was to have accuchecks done at 6a,,, and the nurse on duty then,,,, give ins/coverage if needed,,,

Dayshift monitors,,, and rechecks,,, accucheck prn,,,,,,,

This way,,, ins/ coverage given at time of ordered accucheck,,, another shift didn't have to medicate based on value recieved two hours prior,,,,

Works better for us this way,,, but also,,,, the night shift,,, has few meds to give,,, prior to day shift,,,,, so they have time to do accucheck,,,, give the injection,,,,,,

Happy Holidays ~kitamoon

[itsme]

nurses do accu checks at 0600, insulin at 0630, breakfast at 0700. night shift ends at 0645, day shift begins at 0630

[panda_181]

The lab does our accuchecks, which helps with the time factor, but it's happened more than once that a patient got missed then we have to call them back to come and do it...that's a pain...would be easier if we could just do it ourselves. But in another hospital I was at, they did them themselves and it was done on the night shift...I never saw any problems with it, although I do agree that it should be done as close to insulin time as possible..a lot of things can change in an hour...

Amanda :)

[flowerchild]

In the last hospital I worked at: AM shift starts at 0700, accuchecks done by CNA between 0700-0730, Insulin at 0730, breakfast at 0800. VS, I&O's, etc done by CNA at 0800. The night shift woke the patients and got them up between 0600 and 0700 if they had to go to therapy, xray, etc in the AM, otherwise day shift would get them up after breakfast. Having the night shift get those early to go patients up and dressed enabled the CNA the time to do the accuchecks at the very beginning of the shift. I agree, I wouldn't want to give insulin, especially Reg. based on a reading that was 2 hours old and would probably recheck the accucheck just before giving the insulin if I was in your situation.

The only problems I ever had with giving coverage was when the patient decided not to eat their breakfast and I had already given the regular insulin.

[baseline]

Where I work, it depends on the unit d/t different meal delivery times. On the unit I worked, the trays came early as most of our patients were going home or going to procedure, so the night shift the whole speil.

[nurseleigh]

I asked this in the other thread and I will post it here as well, why are the CNA's doing Accuchecks? I am a CNA and that was never a part of my training(until I got into the LPN program) and where I work the Nurses have to do them.

So, my question is are the CNA's suppose to be doing them and did they get training to do it at the facility or at school?

Thanks

Leigh

[sanakruz, ADN]

Here in CA a CNA does not do bG monitoring, no way.

Guess it varies from state to state. I think CNAs could very well handle such a task- But these poor women and men are already under paid and over worked, and have little status to boot.

This is probablly, bottom line, a staffing issue. One should be able to do the check, give the insulin and move on without that potentially dangerous "window". Enough staff would solve this, no?

[Nurse Ratched, RN]

At my facility, the policy is that night shift does the a.m. BG about 7:15 only if the pt does not get humalog (either scheduled or SS.) Night shift administers non-humalog insulin. If humalog is a possibilty, day shift does the BG's and gives the insulin. It's a little hectic first thing in the morning, but it what is referred to as "point of care testing" and the intent is to give the insulin at the time the BG is obtained precisely for the reason that you are not then giving insulin at 7 am for a BG obtained at 5 am.

Since there is only one machine, we typically have one nurse do the blood sugars and we split up the diabetic patients so one nurse isn't drawing up insulin on several diabetics. It doesn't work perfectly - there is still a lag of about 5-10 minutes between the check and the insulin, but it beats the two hours we used to do.

Techs do not do BG's at my hospital.

[Rena RN 2003, RN]

in the long term care facility that i work in, nurses only do BS and insulin admin. this is done by dayshift which begins at 0700 and breakfast is served between 0730 and 0800.

in the hospital where i do clinicals, the CNAs to the fingersticks anywhere between 0530 and 0645. dayshift then comes on at 0700, looks at the recorded information, and gives insulin accordingly. breakfast isn't served until 0800.

as far as i know, it has been no problem. but i did notice that some nurses would recheck before giving sliding scale because it had been 2+ hours since the finger stick was done. and i agree with this especially if the patient is very brittle. i just think it's sad that a better system couldn't be in place to keep the patient from receiving a finger stick that could have been avoided.

nurseleigh - the techs at the hospital have been trained on the skills of taking an accucheck. they have not been told the why's and wherefore's of getting those checks as close to meal time as possible.

[KaroSnowQueen, RN]

I worked in LTC and aides did not do fingersticks. Now I work in the hospital in a different neighboring state and the aides do ALL the fingersticks. They also draw blood for labs.

At my facility, the aides get the f/s, the night nurse gives the routine, long acting insulin, and the day shift gives any short acting insulins with breakfast.

Days starts at six forty five, nights ends at seven fifteen, and breakfast is at seven forty five.