Coordinating insulin admin +/- 15 mins of tray being passed

[bclem05]

Hi everyone, my question is on how you deal with morning glucose checks and insulin administration? I work on a busy tele floor where the night shift is currently doing the morning glucose checks and coverage around 0600, trays aren't passed till around 0730. As you can see this is problematic. A little background info, nearly all of our patients are on a sliding scale with Aprida and we do 12 hr shifts 7 to 7. Currently management is looking at passing the morning glucose checks to the day shift so insulin will be administered within a 15 minute window of the breakfast trays being passed.There is a lot of negative feedback from day shift. They feel that the morning hour is already too busy and they just won't have enough time to accomplish everything plus morning glucose checks and coverage.

So my question is how do you guys deal with morning glucose checks and coverage?

Who (day or night shift, RN or CNA) checks the blood glucose and at what time? who is administering the insulin and at what time? and how fast are trays received after insulin is administered?

Thanksin advance

Brett

[CDEWannaBe]

Never give insulin based on a reading more than 30 minutes old. Frankly, I wouldn't dose off a blood sugar check more than 10 minutes old.

Blood sugar is constantly changing and am results can be affected by long acting insulin taken the day before and by the natural rise in blood sugar we all have called Dawn Phenomenon where the liver releases stored glucose, causing an am blood sugar rise.

[hecallsmeDuchess]

On my unit, if the pt is AC/HS the day shift does a total of three blood sugar checks and administers insulin as needed per sliding scale or however it is scheduled, then the night does one check and covers accordingly. We were told we are not supposed to administer insulin if the blood sugar has been an hour old, and are asked to recheck the sugar if it's been an hour before then administering insulin. This causes a few problems because sometimes the CNAs want to do sugars at 7am, trays might not show up till 8:30 and so on. Usually, when I have diabetic pts, I ask the tell the aides to do the sugars at 7:45, sometimes they agree but other times they hesitate. When they are unwilling, I ask them not to do it and get it myself because ultimately I'm responsible for the pt.

Our night shift usually gets sugars around 8pm, then give HS snacks and insulin as needed. The pt receives no other check (unless something out of the ordinary happens ie symptomatic hypoglycemia) till dayshift checks it before breakfast. The biggest headache is unreliable meal times, if we can get the a set time for meals, it'll help out a lot and we might have tighter blood sugar cotrol on the unit.

[classicdame, MSN, EdD]

the nurse who is there when food is delivered should be the one who checks MS and administers meds. Period. Forget about shift change and nurse convenience. This is a necessity

[delphine22]

For our sliding scale coverage, we give R, not Apidra, but yet the instructions are still to give with the first bite. *facepalm*

[Anne36, LPN]

When I was in Nursing school we were told to wait until the tray is in front of the patient. Well, I have over 20 patients to give dinnertime meds to, and 6 of them are Diabetics who need sugar checks and insulin with dinner that is served at 5:30 in 2 different dining rooms or someone may decide to stay in their room. So, Im doing a half dozen people who need their pills, checks and insulin all at the same time. I do the best I can, but I cant be in 6 places at the same time.

[classicdame, MSN, EdD]

I think the nurse who will be feeding the patient should give the insulin. There is no quarantee that the tray will arrive exactly at 0800 or any other time. The best solution I worked with was in a pedi hospital. The trays were delivered to the NURSE, not the patient (we had a special area). The nurse then took the tray with the insulin and glucose meter to the patient. Not always feasible, I know, but we never had issues with hypoglycemia that way