Co-sign Insulin?

[FireStarterRN]

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.

[meandragonbrett]

Morte, it's not an issue of the co-signer watching you give the insulin.....It's about having the dosage double checked. We have a space on our MAR that is for the person to sign witnessing the dosage. It specifically states "Witness Signature:_________ Dose Witnessed:_______"

[morte, LPN, LVN]

Morte, it's not an issue of the co-signer watching you give the insulin.....It's about having the dosage double checked. We have a space on our MAR that is for the person to sign witnessing the dosage. It specifically states "Witness Signature:_________ Dose Witnessed:_______"

so you are putting your signature on an MAR that says that nurse A gave such and such a dose...AND YOU DONT KNOW THAT SHE DID?

[meandragonbrett]

No, your co-signature states that you witnessed the dose that was drawn it. It doesn't state that you sat there and watched the other nurse give the med, nor does it state that the nurse gave that dosage. It simply means that you witnessed the dosage that was drawn up into a syringe.

[Happeetxn]

No co-signing insulin for us. If I had a co-worker who wanted me to do it I would not have a problem doing that, but like I said it is not our institutions policy. If I ever have a question concerning a med dose I don't hesitate to track down one of the more experienced nurses and consult with them. Kind of off topic but just wanted to throw that out there.

Craig

[nici1978]

i have to say i like the idea of cosigning, in my facility we cosign subq insulin and trips also all heparin and pca, epidural , it does not make me feels stupid or like i am a bad nurse, no i think it is a step in preventing fatal mistakes from happening

nici

[lpnstudentin2010, LPN]

Factor in all the wandering for other reasons, like searching for equipment. I think we spend far too much time wandering. I thing there is a good reason for having insulin double checked, but there has got to be a better way.

Do not flame me for what I am going to see, this is just an idea, I am not a nurse so i do not know if this would be possible, and I understand that there is already understaffing.

Maybe if there was one nurse on every unit that you could call to come and verify dosage, like that was her primary job, and when she was not needed for that she would pitch in and help with other things.

[Virgo_RN, BSN, RN]

Sometimes we have a "resource" nurse, who assists with admits, IV starts, etc., but calling the resource to come check an SQ insulin dose would be frowned upon. That's not really their purpose. Since there are other nurses on the floor who have patients on SQ insulin, there *should* be someone around to check with, and you can check each other's. I think it's a good idea to double check, but it can be a pain when the sliding scale involves ranges rather than calculations, you only have one unit to give, and everyone else is slammed so you can't find anybody with time to go to the MAR, look at the order, look at the lab slip, go to the med room, look at the vial of insulin, watch you draw it up, and verify that you drew up one unit of X type of insulin. I'm all for procedures that protect patient safety, but come on. If the order involves actual mathematical calculations, mixing of insulins, larger doses, etc., then by all means, having another nurse verify is smart and worth the time involved in tracking someone down to go through the process.

[nghtfltguy, BSN, RN]

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.

exactly!!!

i do some prn work @ an LTC....

i know exactly what she means.... i do nights and im the only RN there when i work.. the lpn's don't have to come to me... you just have to be able to read a sliding scale...and know that the lantus is in the fridge!!

ya do it yourself.... no co-signing... only thing you have to co-sign on is wasting narcs....

[Sunflowerinsc, ADN, RN]

so you are putting your signature on an MAR that says that nurse A gave such and such a dose...AND YOU DONT KNOW THAT SHE DID?

Every place I have worked ,has been policy to co sign insulin. Not that a nurse gave such and such but that the Right kind of insulin and amount has been drawn. Also sign all drips, insulin or heparin and PCA's. It's not that hard or time consuming to have someone there to sign for you. ( I don't know about LTC) Errors have been avoided with co-signing insulin, especially with having newer and more kinds.