Blood Glucose Monitoring w/o Dr.'s orders

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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!

Specializes in LTC, Hopsital, MD Office, Home care.

I think it's funny that this is even an issue. Of course the facility is covered to do a PRN blood sugar on someone who is symptomatic. Why else, without an order or outside of the routine orders, would you check someone's glucose? Unless this child is receiving insulin, there would be no way his sugar would DROP AFTER a feeding; or, I guess, unless he's a VERY active child. Remember exercise and insulin are the only two things have the ability to lower glucose. If it's a case of insulin, then definitely get ahold of the parents or the doctor right away regarding checking that sugar and possible lower the level of insulin. In short, if the blood sugar/feeding routine seems to be that unstable, then intervention does need to take place. THAT is the true question, not whether the sugar can be checked on a PRN or routine basis without an order.

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"Unless this child is receiving insulin, there would be no way his sugar would DROP AFTER a feeding; or, I guess, unless he's a VERY active child. Remember exercise and insulin are the only two things have the ability to lower glucose."

evidently not...he does not take insulin...absolutely no insulin, and he has CP...so he can only be as active as his wheelchair allows. I'm with this child from 8-4, unless he's got a dose of insulin in his backpack that he magically administers to himself...he isn't on insulin.

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In my understanding, blood glucose monitoring is a perfectly acceptable nursing measure to rule out hypoglycemia in a patient that might present with symptoms (non-responsiveness, diaphoresis, etc.) but a routine screening would be super easy to get as a doc's order ... just a phone call away. I guess I'm not quite sure why your sup is so reluctant. Tube feedings DO need consistent blood glucose monitoring, without a doubt, and I would be reluctant to be giving them without it and are, as a result, just as easy to back with a doc's order. Doctor that comes around to the school? Are you in a hospital or school? Just a little confused, I guess.

If a patients blood sugar has dropped as low as 33, I would check it too. you may hate to hear that your supervisor is right. This is just using nursing judgement. You do not need an order to check a blood sugar much like you do not need an order to check a blood pressure. If you still feel uncomfortable, as the other person said, just get an order.

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If a patients blood sugar has dropped as low as 33, I would check it too. you may hate to hear that your supervisor is right. This is just using nursing judgement. You do not need an order to check a blood sugar much like you do not need an order to check a blood pressure. If you still feel uncomfortable, as the other person said, just get an order.

His blood sugar has dropped ONCE to 33. His blood sugar is usually okay, the lowest it has been since then is 55 which is still very low but I think I should only check it without dr's orders when he is symptomatic..

let me clarify somethings again:

-he isn't diabetic

-he isn't receiving any type of insulin

-he isn't PO fed

-he takes polycose

-it dropped to 33 AFTER I fed him and my supervisor said it was because I fed him 15 minutes early

-my supervisor wants me to check his BS with every feeding (bid) symptomatic or not

-we have no doctor's orders or protocols regarding this

my conclusion is this: nursing judgment will cover me as long as he is symptomatic, otherwise I need a doctor's order to check it regularly.

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Specializes in Cardiac Telemetry, ED.

I agree with your conclusion.

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I agree with your conclusion.

thanks :nuke:

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so here's another question....

since my direct supervisor, who's an RN, is the only head medical person at the school I work for.. (it's a state school, btw) everyone believes her opinion on any situation is the right one since she is the RN and I am the LPN...who should I go to or where do I go to get protocols?

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Specializes in Cardiac Telemetry, ED.

I found an example of a school board policy on CBG monitoring:

http://www.palmbeach.k12.fl.us/policies/5_3212.htm

I would check with the agency that administers the school.

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Specializes in Everything except surgery.
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:

"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!!!"

Excuse me but that are several statements about no MD orders were needed to obtain a blood sugar on a patient! No where was it said that this patient was on insulin!

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