blood sugar checks and insulin

[makes needs known]

Our nurse manager is trying to find ways to get more work done in a timely fashion. We just started this, one nurse passes meds and the other nurse comes along and checks blood sugars and then the first nurse comes back and gives the insulin based on blood sugar check. Any comments or problems that you can see?

[Forever Sunshine, ASN, RN]

Thats what we try to do in my facility but I will end up going ahead and doing fingersticks and insulin if they don't do it. I don't mind. I get them all done(or try to).. before dinner. If I don't get to them, or find them, then the world goes on and I get it as soon as they get back from dinner.

[caliotter3]

Not enough nurses for this unless you start a little early and get a routine down.

[classicdame, MSN, EdD]

if BS is too high or low I assume you have to draw blood. Who will do that? How do the results from Nurse 2 get to Nurse 1?

[wiley6coyote]

I am just curious why you would have to draw blood if BS was too high or low? In LTC this is not an option and also, I have a child with type 1 D and highs and lows happen alot -

I think it would be less time consuming to have the med nurse do the check and give the insulin , it takes very little time to check a CBS and if you have the med cart with you, you can give the insulin right away rather than going back after someone else has checked the blood.

[SuesquatchRN, BSN, RN]

I've worked in places where the treatment nurse did the sticks and gave them to the meds nurse. It worked well.

[Orca, ADN, ASN, RN]

I am just curious why you would have to draw blood if BS was too high or low?

Glucometers tend to be much more inaccurate at the upper and lower limits of their ranges. A lab draw gives an accurate picture of what you are dealing with. It is impossible to know how much insulin to give if the only glucose reading you have is HI. Every hospital I have worked in has had a policy that a lab draw is required to verify readings above or below certain limits (most commonly, anything below 40 or above 400).

[CapeCodMermaid, RN]

Orca...this is long term care. If we waited for a lab tech to come and draw blood to check a high or low result, the resident could be in serious trouble before they arrived. I, for one, would never give insulin based on a blood sugar someone else got...but then again, I've been doing this forever and I'd never give a med I hadn't poured myself or sign off something on the TAR if the CNA did it.

[Ms.RN]

Hmm.. Why cant nurse #2 check blood sugars and give insulins based on their accucheck result? I read some place that nurses made up blood sugar results. Maybe I'm being too paranoid.

[debRN0417]

I used to go get all my blood sugars first, then give the insulins. I do my own blood sugars. I am liable for the amount of insulin I administer.

[makes needs known]

Thanks for all your comments, I'm on vacation for two weeks now and when I get back to work they will probably have some new system designed to make up for the fact that they need more nurses. Plus our floor looks like LTC but it is really a rehab floor that has many things going on. 40 patients, hip repairs, knee replacements, new CVA's, respiratory patients. All people who are just here to get strong and return to their previous home. We need more nurses, so people in pain get their needs taken care of and don't have to wait. 40 pts and 1 med nurse is not fair to these people and not fair to nurse. So management keeps rearranging the way we work.

[TheCommuter, BSN, RN]

if BS is too high or low I assume you have to draw blood.

Every hospital I have worked in has had a policy that a lab draw is required to verify readings above or below certain limits.

In the realm of long term care (nursing homes), staff does not perform venipuncture or lab draws. We call an outside laboratory to do all blood draws, and it might take them 4 hours to arrive at the nursing home for a STAT order that we called in to them.

If a glucometer reading is extremely high, we call the physician and proceed based on the telephone orders that we have received. Usually, the MD will instruct us to give a specific amount of regular insulin and recheck the blood glucose in 60 minutes. If the glucometer reading is low, facility protocol is to give 4 to 8 ounces of juice if pt. is conscious enough to swallow, or give Glucagon IM or SQ if pt. is losing consciousness, then recheck the blood glucose level in 15 minutes and 60 minutes.