Cosigning meds

[ICUNurseG]

My hospital recently changed computer systems and are now required to cosign insulin and heparin. We cosign for ALL heparin and insulin, including SQ heparin and when we have an infusion of either one and are just changing the bag. Prior to this we did not cosign anything.

It has not been well received. I can see the rationale behind signing sliding scale insulin or when calculating a heparin Bolus.

The complaints I've heard are mostly due to time constraints. I've also heard people say that we give far more potent meds (I work MICU) and those don't require cosignature.

I am joining a sub committee on this and would be interested to hear some outside views/policies. Thank you!

[j0yegan]

We do that at my hospital as well. No one likes it. You're spending time trying to find another nurse just so they can co-sign with you on the computer. And sometimes, when they co-sign, the computer doesn't want to accept it. And then you have to find some OTHER nurse, or call IT to tell them that all you're trying to do is give some stupid medication that you can give by yourself. All of these little things they're adding on really makes the job more stressful.

[nynursey_]

My hospital policy is that all insulin, basal or bolus, requires a cosignature. Heparin drips require a cosignature for initial blouses and rate changes. And any advanced cardiac med (Dilt drip) also requires a cosignature. PCA pumps also require a cosignature.

[ICUNurseG]

Thanks for your input. It's such a hassle and a lot of nurses don't actually look, they just cosign. I usually do check, since I feel that cosigning is basically putting my license on the line for another nurse.

[Esme12, ASN, BSN, RN]

Places I have worked have always co signed insulin and heparin and I have exclusively worked critical care and the ED....for 35 years. It is a pain but saves many catastrophic mistakes. These are amongst the MOST common mistakes statistically. You are signing that you observe the correct dosage. Those nurses who sign and don't look may someday find this blow up in their face.

Nurses are the hardest to change policy on for we thrived on things being the same. Repetition is our safety net. You will soon get used to this new inconvenience.

[nynursey_]

Thanks for your input. It's such a hassle and a lot of nurses don't actually look they just cosign. I usually do check, since I feel that cosigning is basically putting my license on the line for another nurse.[/quote']

My hospital uses Vocera, so finding another nurse to cosign isn't typically that hard. We just fire out a broadcast saying we need a cosignature, and usually within 5 minutes, someone is in the room at the ready.

[Twinmom06, ASN, APN]

SQ heparin doesn't require a co-signature, and neither does SQ insulin at my facility. Insulin gtt's do require co-signature and rate changes on hep drips do too...the last facility I was at (for a short time) required co-signature on SQ insulin as well - I feel that's just an unneeded step in an already hectic dayshift!

[1fastRN]

Just for drips in my ETD. Nothing for SQ. And I always verify before signing, and when it's my med I ask the other nurse to check my math.... nurses get tired too, especially at 5am I feel more confident when someone else "checks my work."

[nynursey_]

I thought I'd clarify too that my hospital does not require cosignatures on SC Heparin injections, just drips. ?