Co-signature for Insulin administration

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Hi All!!

I am a new RN and hope to get job at a hospital or nursing rehab so I can build my nursing skills and confidence.

I have heard rumors that some cna/pca dont check blood surgar of pts

and just write a random number. What do you do if you suspect this? Should a nurse check the blood surgar just to be on the safe side for each pt that may need insulin?

Also I would like to know do nurses co-sign to adminster insulin? What do you do if you are alone for example a school nurse or your alone on the unit?

Thanks!

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Specializes in Psychiatric nursing.

When I worked in a private psych hospital all insulin required the signaure of two nurses. If you were the only nurse on the unit, you couldn't give the insulin until the supervisor came up and signed it off with you. In my current job in a medical hospital, the policy is to check the dose with another nurse, but it doesn't require the second nurse to sign anywhere. Hope this helps.

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Specializes in Gerontology.

Slight off -shoot.

My cat is diabetic and I have to give him insulin twice a day. The first morning I drew it up, I double checked the dose and then looked over my shoulder for a collegue to double check it! Um yeah - I live alone. I felt so uncomfortable giving that insulin without a double check! LOL.

As for blood sugars as a Canadian I do everything (and I mean everything) for my pt. I would not feel comfortable giving insulin according to a blood sugar I did not do. Esp if there was a chance it was made up. I would just tell the CNA that I would do my own blood sugars.

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Specializes in Critical Care.

There's always a risk when you can't confirm information, although every glucometer available these days should store the BG reading history, so you should be able to at least confirm that they've actually been checking BG. The glucometer we use scans the patient ID then downloads the reading to the EMR, which helps prevent any 'fibbing" about readings.

Our facility to longer double checks for SQ insulin, there's no evidence that it reduces errors.

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Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

Our patients need to have their bracelet scanned before it will let you take blood. I'm sure there's a work-around but it's easier at that point to just do it

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Specializes in Emergency, Telemetry, Transplant.

In the ER, we are not required to have a 2nd check with another nurse cosigning an insulin dose. It was very strange, but I often still have another nurse look at the dose before I give it, even if I don't have them cosign.

As for the blood sugar value...the tech must scan a pt's wrist band before taking the CBS, then the results are posted to the chart. Now this does not insure that the tech did the procedure correctly. The problem is, if you doubt the tech is doing the job on this, now you have to second guess everything the do. Did the make up that BP of 139/81 or could it really be 190/95? You cannot recheck everything they do. It it seems strange, recheck it. Also, you will learn which techs you can trust and which you may need to watch a bit more carefully.

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Specializes in ER, progressive care.

Where I work, the glucometers load the blood sugar result into the patient's electronic chart. We have to scan the patient's arm band before testing. Our CNA's will tell us the patient's blood sugar after getting the result, but sometimes they will tell us the wrong number...I almost gave the wrong dose of insulin because a CNA told me a blood sugar was in the 200's but really it was in the 100's! Now I always check the computer once the result loads into the system, unless I check the patient's sugar myself.

We also have to have two RN's co-sign on insulin. Not sure how it would work in a setting where you work alone.

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Specializes in Emergency.

My facility doesn't require two RNs for insulin.

We also have glucometers that upload the BG into the EMR. The only time I ever dose insulin without seeing it in the chart is if I happen to be in the room when the sugar is checked & I see the number with my own eyes or if I check it myself. Too many instances where the tech tells me the glucose and it ends up being very far off from what uploads.

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Specializes in ICU.

A little off-topic, but I have never heard of "CBS" until I came to this site- what does the "C" stand for?

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Specializes in Emergency.
A little off-topic, but I have never heard of "CBS" until I came to this site- what does the "C" stand for?

I'm not familiar with it either. Perhaps capillary blood sugar?

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Yes, capillary blood glucose.

In several facilities I've worked, not only did we not not co-sign for insulin but we also adjusted the doses ourselves based on various factors and just updated the practitioners. Co-workers at another hospital nearly fell over when I told them that one.

I can't stand having my insulin double-checked. It's a waste of my time and insulting my intelligence. I mean, honestly how many RNs does it take to screw in a light bulb? Besides, this facility just makes us get the signature but probably 75% of the RNs don't *actually* double-check.

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Specializes in Emergency, Telemetry, Transplant.
I can't stand having my insulin double-checked. It's a waste of my time and insulting my intelligence. I mean, honestly how many RNs does it take to screw in a light bulb? Besides, this facility just makes us get the signature but probably 75% of the RNs don't *actually* double-check.

I tend to agree. I worked at a facility where we had to get another RN to cosign our coumadin doses before we gave them...even more silly!

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