blood sugar monitoring w/o doctor'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!

I'm going to try and explain a little bit..it's very confusing!

so like I've said, I work at a school for developmentally delayed children..most of the children up there also have parents who do not take part in the care of their child (medically)

before I came to the job, my workplace didn't own a glucometer (i donated one) ...this patient has had previous lethargic episodes and my supervisor suspected hypoglycemia but never motioned for a glucometer ...her reasoning for his blood sugar dropping changes...at first, she blamed it on me feeding him 15 minutes earlier than scheduled...I mean she's had several different reasons..

The child is not a diagnosed diabetic. His blood sugar dropped to 33 and we called his mother (I do not make the decision on taking a child to the ER or we would have been up there as soon as it happened) We have a hard time getting his mother to take him to the doctor for his other medical problems (VP shunt, so on..) and she didn't take him to the doctor that day either. When the doctor finally saw the child, the blood sugar was normal..so he doesn't think there's a problem and suspects that it's something the nurses are doing wrong..so, according to the supervisor, the doctor refuses to sign a doctor's order...I have something in writing from a different doctor that comes to the school that says it's okay to check it when he has s/s of hypoglycemia..

I called my State board..and they said it falls on the DON..:up:

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I was under the impression that acu checks can be a nursing order/judgment. Many of times I have done an acu check(with out an order and the pt is not diabetic) if my pt LOC changes, or other symptoms appear. In fact that is one of the 1st things I check is a blood sugar..too low, have some juice please. Too high, call the MD.

And most likely where you work has a protocol that says you can do this. There is really nothing that can be a nursing order, we can't prescribe. When you can do things under Nursing Judgement it is because you have a protocol where you work that covers you to be allowed to do that. Such as putting O2 on a patient that is not breathing well, an EKG on someone with Chest pain, etc all of these things are covered under hospital protocols or Nursing home protocols, etc.

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we don't have any nursing protocols regarding things like that...we have protocols about medications and amounts...but nothing for o2 or accu checks ...thanks for your help! :yeah:

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we don't have any nursing protocols regarding things like that...we have protocols about medications and amounts...but nothing for o2 or accu checks ...thanks for your help! :yeah:

Just tell your boss you need protocols for such things

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Specializes in LTC, Med/Surg, ICU, clinic.
My first question would be what are you going to do if the blood glucose is high or low? If you don't have a protocol in place to guide you, then why do the blood glucose? Only way I would do it is if the child is symptomatic. However, to routinely do this, especially when the parents don't know, is practicing medicine without a license.

Agreed. Trust your gut and commit to an outcome. Having numbers is one thing, but what are you going to DO with them that will benefit your patient (ie: follow protocol). If you're uncomfortable, don't fight that. Easy for me to say, though, right? Suggest speaking with the child's physician, maybe arrange a family conference to discuss issue, and develop a protocol.

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