Caught a bad insulin error today

Published

Specializes in OB/GYN, Peds, School Nurse, DD.

I'm a school nurse(elementary) so I have contact with our students with diabetes several times a day. One of them is young and her sugar has been very labile. She can come in at 8:15 at 389 and by lunch she's down to 70 or below. She comes up at lunch(I actually give her insulin AFTER lunch so I can look at her tray to see how many carbs she actually ate--she's a picky eater.) I check her BG correction, then her carb correction, then give the insulin, which I triple check. It is not uncommon for her to be back in teh clini within 2 hours, somewhere around 49.:eek: This kid scares the bejeezus out of me!

Okay, today was the final straw. Another very low episode after lunch. I even went back and rechecked the insulin dose thinking that maybe I had done something wrong? Nope. In fact, when i went back and looked she has had EIGHT low episodes in the past 10 days!(I've been out since last week.) Holy cow! I picked up the phone and called the doctor direct(usually, we get orders via the parents). She asked me to read her lunchtime carb correction--18 carbs per 1U insulin. "What? That's not right! Its FORTY carbs per 1U insulin!" :uhoh3: All-righty then. I'm looking right at the original doctor's order and it very clearly says 18. This kid has been getting TWICE the insulin dose she should have for the past 2 WEEKS. :eek: OMG! It's a wonder we didn't kill her! I faxed the orders, the consent to contact, and all her logs for the past 2 weeks. I fully expect new orders on my desk in the morning. If not, we will be having another pow-wow, because I am NOT going to follow this order one more day! :mad::mad::mad:

Up Vote Up Vote ×

Thank goodness she has a nurse who is willing to make sure things are right!

Up Vote Up Vote ×
Specializes in Family Nurse Practitioner.

Wow, thank goodness you followed up on this case!

Up Vote Up Vote ×

How frightening! And people think being a school nurse is easy.

Good on you for following up. that was a serious, serious error.

Up Vote Up Vote ×
Specializes in ICU, PICU, School Nursing, Case Mgt.

Great Catch!

I did elementary school nursing for 3 years and it is NOT easy! You are on your own and in addition to being a good nurse you also have to be a good detective!

Also have to be a super advocate for the children. I called DCF 6 times in 1 year over very sad issues. It is disheartening to see what some of these little kids go through.

Keep up the good work Sherlock!

s

Up Vote Up Vote ×
Specializes in OB/GYN, Peds, School Nurse, DD.

Everything you say is true. Lots of people--and even nurses!--think of school nursing as bandaids and ice packs, but it is soooooo much more. I work every bit as hard as i ever did in the NICU, just a different set of issues. Child abuse is the worst. Untreated injuries sustained at home are always a worry. Kids coming to school with contagious illnesses(like the one who came to school with Hep A for TEN days before we found out he had it!)

I guess the think that awes ME is how much faith the PARENTS put in me. They send their little children to school everyday on faith that I will make good decisions and take care of their precious children until they come back home. I don't know how they do it? If my child was like my little diabetic, i think I would lose my mind with worry! How come they trust me? I don't know. But it's a BIG responsibility and I never forget that these are somebody else's children.

Up Vote Up Vote ×
Specializes in home health, dialysis, others.

I was a school nurse for a while, and I agree that it is much harder than it was years ago. Asthmatics, diabetics, special needs kids and an amazing amount of meds.

Oy Vey!

They trust you because they have assumed that you love their kids, and they are happy that SOMEONE is looking after their precious child.

Up Vote Up Vote ×
Specializes in ICU, PICU, School Nursing, Case Mgt.

Not to mention that you have to have patience...not with the children but the PARENTS!

There were many times I thought that stupidity should be a diagnosis.

There should be a test that must be passed in order to reproduce...cant drive without a test...but people have kids without thinking twice about the responsibility. (or thinking at all)

One of my classic cases was a 23 year old mother who had 6 kids. We had the second grader, first grader and kindergardener in our school. At home were the 4year old, 2 year old and 4 month old. This happened to be one of the kids I called the DCF on, since the first grader came to school with his heel so badly lacerated that it flapped up and down like a flip flop. Obviously the kid couldnt walk. I attempted to reach the mother all day...surprise, no one answered. Long story short,the child protection team escorted the child home and saw that he was taken to the hospital. I was on that mothers hit list for a long time. I was actually a little nervous as she threatened to "get me". No concern for her child, or any gratitude for obtaining medical care for her kid...she was gonna "get me".

I was also appalled at the number of kids on adderall, ritalin, focalin, and everyother form of kiddie amphetamine there is. Also, Geodon and Abilify, what is the matter with the world today!

Some how the kids all seemed to make it ok without that stuff when I was in elementary school!

I have had alot of experience in peds and PICU and I have two grown children of my own so I know about kids...dont understand all of this medication now...and I am far from old fashioned...I just dont get it.

Maybe if parents would spent a little more time paying attention to their children and interacting with them the kids would not act so "hyperactive". They all dont need to be drugged...just made to feel like they are loved.

s

Up Vote Up Vote ×

I agree, I'm not even a nurse yet, and I think it would not be too easy. My mom's a teacher and she tells me all the time about all the kids she has that have special needs, whether it be prescriptions or insulin etc. At least in a hospital you have other nurses to consult with! Good job!!!

Up Vote Up Vote ×
Not to mention that you have to have patience...not with the children but the PARENTS!

There were many times I thought that stupidity should be a diagnosis.

There should be a test that must be passed in order to reproduce...cant drive without a test...but people have kids without thinking twice about the responsibility. (or thinking at all)

One of my classic cases was a 23 year old mother who had 6 kids. We had the second grader, first grader and kindergardener in our school. At home were the 4year old, 2 year old and 4 month old. This happened to be one of the kids I called the DCF on, since the first grader came to school with his heel so badly lacerated that it flapped up and down like a flip flop. Obviously the kid couldnt walk. I attempted to reach the mother all day...surprise, no one answered. Long story short,the child protection team escorted the child home and saw that he was taken to the hospital. I was on that mothers hit list for a long time. I was actually a little nervous as she threatened to "get me". No concern for her child, or any gratitude for obtaining medical care for her kid...she was gonna "get me".

I was also appalled at the number of kids on adderall, ritalin, focalin, and everyother form of kiddie amphetamine there is. Also, Geodon and Abilify, what is the matter with the world today!

Some how the kids all seemed to make it ok without that stuff when I was in elementary school!

I have had alot of experience in peds and PICU and I have two grown children of my own so I know about kids...dont understand all of this medication now...and I am far from old fashioned...I just dont get it.

Maybe if parents would spent a little more time paying attention to their children and interacting with them the kids would not act so "hyperactive". They all dont need to be drugged...just made to feel like they are loved.

s

From the mother of one very hyperactive child: Stop judging other people. Some children are hyperactive and need meds to help them focus. In your day, those people ended up flipping burgers or pumping gas, instead of reaching their maximum potential. My son is headed to college soon, because his mother cared enough to get him the help he needed.

Up Vote Up Vote ×
From the mother of one very hyperactive child: Stop judging other people. Some children are hyperactive and need meds to help them focus. In your day, those people ended up flipping burgers or pumping gas, instead of reaching their maximum potential. My son is headed to college soon, because his mother cared enough to get him the help he needed.

Off topic here but I agree. Some children are actually ADHD and need medication to help them focus. Not every case is a case of bad parenting. :rolleyes:

Up Vote Up Vote ×
Specializes in ICU, PICU, School Nursing, Case Mgt.

Sorry Guys,

I did not mean to imply that ADHD does not exsist or that it needs to be treated.

And I Absolutely did not mean that I believe that it is caused by bad parenting.

Case in point-my 7 year old grandson is AHDH and takes meds and yes it helps.

What I ment was-I had an exceptionaly high number of kids on these meds for the size of the elementary school. And when my kids were little there were far fewer cases.

And actualy, I dont believe that the ADHD kids who were not medicated grew up to "flip hamburgers or pump gas"...think of Robin Williams-he's self admitted ADHD and there are many more extremely successful people...so, Alicia, I'm not sure where you are coming with that one.

So, now back to the original topic...

Mea Culpa,

s

Up Vote Up Vote ×
+ Join the Discussion