Delegations: continuous glucose monitor

[AAG]

I work in community based care and I am looking for advice on delegating continuous glucose monitoring. Checking blood sugar with a finger poke can be a taught task, however, I am curious if anyone has delegated application of a Dexcom monitor or Freestyle Libre monitor. Anyone have advice if that could also be a "taught task" or would that require delegation? Is it considered a nursing skill?

[Nurse Beth, MSN]

Probably it's a Yes.

Check your facility's policy first. You can also check with your BON/BRN. 

So many tasks nurses perform can be delegated, and it's an intelligent use of resources. Nuclear med techs start IVs; cath lab techs remove femoral sheaths; nursing assistants apply Purewicks; and on and on.

The ANA principles of delegation include:

• Is within the caregiver's range of functions, • Frequently recurs in the daily care of a healthcare consumer or group, • Is performed according to an established sequence of steps, • Involves little or no modification from one care situation to another, • May be performed with a predictable outcome, • Does not inherently involve ongoing assessment, interpretation, or decision-making that cannot be logically separated from the procedure(s) itself, and • Does not endanger a healthcare consumer's life or well-being

It's a matter of delegating the right task to the right person. The RN determines if the unlicensed individual is competent and the level of supervision needed.

It would be essential to document any training/return demonstration involved. Good luck!

[mmc51264, BSN, MSN, RN]

This is something that is going to need to be addressed-both CGMS and Insulin pump sites. Right now, we are not allowed to touch any of these things and are not allowed to use BG from a CGM unless very special circumstances. As a parent of 2 type ones, I wish health care would hurry up and get with the program. Also, the huge increase in people using Ozempic, Victoza, etc, we need to catch up as well. 

Libre is much easier to apply than a Dexcom (and less expensive) I have heard stories that during Covid, some organizations were using CGMs so that nurses didn't have to go into rooms as much. 

My personal experience is that these will change the face of DM2 for the better if everyone that needs one, has access to them. 

[jonnysangel777, LPN, LVN]

Here in the school district that I work at, the district RN trained the health tech I work with to read the BG from my students CGM when she needed to cover for me when I was covering for an aide and doing TFs. The RN also trained 2 other staff who on reading BG on CGMS and then the health tech and the 2 staff were trained on what to do for hyper and hypo glycemia.