Blood Glucose Monitoring w/o Dr.'s orders

MsLady06 · Mar 20, 2008

My supervisor wants me to check my patient's blood sugar bid before his tube feedings. He is a child and I have no permission slip from parent stating it's okay, we have something from the doctor that comes around the school once a week that says we were allowed to check it once...my supervisor insists that I could lose my license for NOT checking it (her explaination: common nursing sense) ...I still do not feel comfortable checking his blood sugar without doctor orders (it has dropped to 33 before after I fed him)...but everytime I ask about it, she starts raising her voice at me and tries to tear me down...I don't know what to do...please help (links to something that says I shouldn't do it...or something that says it's okay to do it would be great...)
thanks!

I see how you feel but its perfectly okay to check a BG without a Dr's order. I just did this with a patient a few weeks back. She had surgery on her shoulder and she was a diabetic but there was no order to check her BG but we still took it. I am a new nurse so the charge nurse was telling me its okay to do it. :wink2:

softstorms · Mar 20, 2008

checking a blood sugar for a pt. has always been a nursing measure in my 20 years. Like any tool we have for assessment B/P, temp,HR, resp/pain level, LOC. Giving a med to change that......then you need the M.D. But Accuchecks are just another vital sign to us.

ohlpn · Mar 21, 2008

In LTC, we frequently check blood sugars without an order. Behavioral changes & other physical symptoms often require "nursing judgement" where chem sticks & other procedures help with assessments of acute changes that need to be addressed to the doctor. Good luck...

luvschoolnursing, LPN · Mar 21, 2008

Don't want to be disagreeable with the crowd but...I'm in a public school not the type you describe being in and I probably wouldn't check sugars 2X/day without at least the parents knowing it. Do they check it at home? Does this child have a reason his sugars drop? Even if it's OK to do w/o a MD order, which I agree it is if it is indicated, I'd want the parents on board as to what was going on with their child.

Also, I'd want MD orders as to how he wanted low/high glucose treated, espeically since child is on tube feed. I always figure even if it's OK to do something, it never hurts to cover your butt!

kels764 · Mar 21, 2008

Don't want to be disagreeable with the crowd but...I'm in a public school not the type you describe being in and I probably wouldn't check sugars 2X/day without at least the parents knowing it. Do they check it at home? Does this child have a reason his sugars drop? Even if it's OK to do w/o a MD order, which I agree it is if it is indicated, I'd want the parents on board as to what was going on with their child.
Also, I'd want MD orders as to how he wanted low/high glucose treated, espeically since child is on tube feed. I always figure even if it's OK to do something, it never hurts to cover your butt!

thank you! :nuke: I'm going to get something in writing from the parent...as for what we do when the blood glucose is too high/low ...911...last time, my supervisor shot his blood sugar up to 145 in a matter of seconds...and since he didn't go to the doctor that day, the doctor had no idea....when the doc checked it at his appt. a few weeks later it was 88...normal...anyway..the hospital is a few feet away, so that's why we feel calling 911 for it is okay...

luvschoolnursing, LPN · Mar 21, 2008

kels-

where are you from? I'm not familiar with the numbers you are using. 145 would be a fine number after eating and 88 would be bordering on too low (at least after a meal). Are you in the U.S.?

Brownms46 · Mar 22, 2008

First of all, any thing that you do to a patient requires a doctors order..period! However, in an emergent situation a nurse may provide emergent care as long as they follow the facility's protocol, and then ASAP (as soon as possible) get an MD to sign an order covering the procedure you performed on a patient!!!

Let me say this, and you deal with it as you see fit. It is your license and not your supervisor who will have a problem if you perform an act/procedure, that an MD will not provide an order for!

The first thing I would be concerned about is why your supervisor refuses to get an MD to write an order. It does not matter where you are working at. If you do anything invasive to a patient you need an order, or your facility should have a written protocol on how to handle such issues!

That stuff using common sense is not how it works in caring for others who are not your family member!

Sorry, but I strongly disagree with the response others have posted on this issue! If anything happens to this patient, and a lawyer can find anything that was not done by the book, your facility will hang you out to dry!

kels764 · Mar 23, 2008

First of all, any thing that you do to a patient requires a doctors order..period! However, in an emergent situation a nurse may provide emergent care as long as they follow the facility's protocol, and then ASAP (as soon as possible) get an MD to sign an order covering the procedure you performed on a patient!!!
Let me say this, and you deal with it as you see fit. It is your license and not your supervisor who will have a problem if you perform an act/procedure, that an MD will not provide an order for!
The first thing I would be concerned about is why your supervisor refuses to get an MD to write an order. It does not matter where you are working at. If you do anything invasive to a patient you need an order, or your facility should have a written protocol on how to handle such issues!
That stuff using common sense is not how it works in caring for others who are not your family member!
Sorry, but I strongly disagree with the response others have posted on this issue! If anything happens to this patient, and a lawyer can find anything that was not done by the book, your facility will hang you out to dry!

that's EXACTLY how I feel about it all...THANK YOU!!!!! I needed to hear that...reassurance that I'm not insane for wanting doctor's orders is nice...

and to answer another person's questions...I do live in south US

70-120 is "normal" according to my books and the hospital

70-170 is "normal" for a diagnosed diabetic child

I really don't understand what's going on...my supervisor's excuse for it shooting so low was because I fed him 15 minutes early. But from what I understand...feeding him will raise his BS....

I feel extremely frustrated...I hear the words "nursing judgement" but when the child is acting completely normal..."nursing judgement" won't cover me for checking it when there's nothing wrong....where I live...you don't get to talk to doctors directly...all you do is talk to the nurse at the office who then relays the message to the doctor and back to you...I'd love to be able to contact his doctor and talk to him...there's a fishy reason why we don't have an order

the whole situation is .....odd. and something isn't right about it.

Jules A, MSN · Mar 23, 2008

Sorry, but I strongly disagree with the response others have posted on this issue! If anything happens to this patient, and a lawyer can find anything that was not done by the book, your facility will hang you out to dry!

Sorry, but I don't really see where anyone was suggesting she not contact the Physicain for a standing order. I agree the facility and her supervisor won't take responsibility and that she needs to contact the Physician herself. However in the meantime I'd be more concerned about being hauled into court for NOT checking a diabetic child that we are giving insulin to than for checking, but thats just me.

:uhoh3:

Virgo_RN, BSN, RN · Mar 23, 2008

She never said the child was diabetic, nor that she is giving insulin. The child is on tube feedings. That is the rationale for checking.

Jules A, MSN · Mar 23, 2008

70-120 is "normal" according to my books and the hospital
70-170 is "normal" for a diagnosed diabetic child
I really don't understand what's going on...my supervisor's excuse for it shooting so low was because I fed him 15 minutes early. But from what I understand...feeding him will raise his BS....

I still do not feel comfortable checking his blood sugar without doctor orders (it has dropped to 33 before after I fed him!

Ooops apparently I don't understand whats going on either although I do realize the rationale for checking bgs with tube feeding, lol. I am still puzzled about the comments that his bgs go low after eating and then I saw "diabetic child" and all this talk about the supervisor and shooting low which I thought means injecting insulin when the bgs are low.

kels764 · Mar 24, 2008

lol I think everyone is confused...even I'm confused and I'm the one in the situation....my theory is..if it's this confusing, something isn't right about the situation haha...