Co-sign Insulin?

[FireStarterRN, BSN, RN]

Here, we still co-sign insulin. When I worked in a nursing home years ago, we weren't required to. I can give many critical and potentially dangerous meds, including managing an insulin drip, without co-signing but we are still required to co-sign insulin for regular administration.

Sometimes it is terribly inconvenient to hunt down another nurse to give insulin. And, it seems silly. Maybe we should start co-signing all our meds? After all, we might make a mistake.

[TheCommuter, BSN, RN]

Blame JHACO for these silly rules.

I currently work at a facility that is not JHACO-accredited, and we do not need co-signatures on regular insulin administration.

[traumaRUs, MSN, APRN]

Subq insulin? Never co-signed for that. However, at the last hospital where I worked, we did have to have a co-signer for IV insulin and/or setting an insulin gtt.

[htrn]

:uhoh3:I hate to say this, please don't flame me:chair:.... but I kinda like the idea of having another nurse sign off on all meds. Handwritten MARS, medex's, poor MD handwriting on orders, drug packaging problems (neonatal heparin) and worsteing eyesight of us old nurses really make me want to ask someone else to double check on what I am giving.

I am an experienced nurse and there are some coworkers that may think I lack confidence or ability - I don't care - I HATE MAKING MED ERRORS:nono:. I would hate to think of a new nurse not wanting to double check a med (any med) because other nurses may criticize them for it.

[classicdame, MSN, EdD]

JCAHO does not require co-signing on insulin. They only require that a policy be created to cover how ALL meds are administered. So if your facility has a policy about co-signing they expect you to comply. Our facility does not, but most nurses like to do it anyway.

[tencat]

When I worked at a hospital we had to co-sign insulin. I kind of agree with the other poster who said it would be nice to have to co-sign on all medications......Not practical, maybe, but I think it would cut down on errors.

[General E. Speaking, RN, RN]

We have to get a co sign on insulin, heparin, Lovenox, etc... "High Alert" meds. Yes, it is a pain in the butt to wander around trying to find someone to sign your MAR. Especially on Med Surg where 5 out of 6 patients can be diabetic and are on ac/hs fingersticks. This amounts to a lot of wandering in 12 hrs.

[TheCommuter, BSN, RN]

:uhoh3:I hate to say this, please don't flame me:chair:.... but I kinda like the idea of having another nurse sign off on all meds. Handwritten MARS, medex's, poor MD handwriting on orders, drug packaging problems (neonatal heparin) and worsteing eyesight of us old nurses really make me want to ask someone else to double check on what I am giving.

I am an experienced nurse and there are some coworkers that may think I lack confidence or ability - I don't care - I HATE MAKING MED ERRORS:nono:. I would hate to think of a new nurse not wanting to double check a med (any med) because other nurses may criticize them for it.

I'm not flaming you :)

However, it is next to impossible to have another nurse cosign my meds when I work in a nursing home, and must pass meds to 30 patients within 60 minutes. Due to time constraints, the act of cosigning for meds is time-consuming and unrealistic in the unique realm of LTC.

[SuesquatchRN, BSN, RN]

I never had anyone check my insulins in LTC.

[not now, RN]

I miss LTC and not needing another nurse to co-sign my insulin. With 53 beds on my side there was no way I could do a med pass and find someone to witness.

Where I am now we co-sign both SQ insulin and insulin drip (both setting the rate and bolus). It's a hassle and eats up a lot of my time especially with the drips since it's every hour.

We are also supposed to have witness when we waste Lovenox, when the amount ordered is less than the pre-filled syringe amount.

[jschut, BSN, RN]

I never had anyone check my insulins in LTC.

I haven't either.

[suzanne4, RN]

Insulin and Heparin are considered high risk medications by JCAHO and other governing boards. How your hospital has things verified is up to them, but if any issues come up, then it is going to be your hospital's neck on the chopping block.

Every single facility that I have ever worked at and that has been for too many years to count always has required a double signature for insulin and for heparin when that is given IV. Even for those on heparin and insulin drips, they have required a double signature when the rate or dose is changed.

And in the NICU world, every single medication has always required a double signature, and that is even for something like Tylenor or Aspirin, same with many PICU units as well, so it is not just med-surg nurses that need to comply with this.

Two sets of eyes are always better than one. Computerized med programs also require the double signature, and so do wastes of narcotics, so it is something that can easily be done.

And after that fiasco with the heparin in Los Angelese, expect to see even tougher rules in place, not get any easier.

----------------------------------

There is also a program in northern CA called the Betty Irene Moore Foundation and the Beacon program is under that, she donated the money for it to the tune of over $10 million dollars for patient safety etc, when she received an incorrect insulin dose that was given to her.

And patient safety is at the forefront of the conferences that they put on.