Conflict with preceptor over re-checking blood glucose

[sweetmama81]

I have started at a new facility. I am not a new nurse, just new to the facility. A patient had a very high blood sugar. I had never seen the BS this high for the patient. I rechecked it to make sure it was not a false high, but it went higher (not by much though) so I went with the higher number. This also required me to call the MD/notify charge nurse. When I told my preceptor what happened, she told me that I shouldn't have checked it again and should have went with the first number. I explained my rationale (that it could have been a false high and I would have been covering with an inaccurate number) and she told me that she had never done this before. She didn't think it made sense. I asked for the policy and she said "just forget the policy for now, what is your nursing rationale?" She said go with the MD order. I have always thought that a facility would have a policy on what to do with abnormal blood glucose, not just hypoglycemia. I was even given a funny look for giving apple juice instead of orange juice (due to severe CRI) when a BS was low. What do you think? What is the policy at your facility? what is best evidence based practice? Appreciate any response.

[toomuchbaloney]

1) Agree to disagree with your preceptor on this.

2) Double check your facility policy but always err on the side of making certain that you are not treating a patient for equipment or test failure. Imagine resuscitating a patient because their monitor lead was disconnected...treating a falsely high or low lab because of user or product failure is the same thing. Especially if the appearance of the patient does not support the result you are seeing.

3) Understand that thinking critically rather than performing tasks by rote is what differentiates professional nurses from other unlicensed technicians.

4) remember that you will be held accountable for what you did or did not do. If something untoward were to happen you would be held to the standards expected from a properly educated and licensed RN, regardless of what the preceptor told you.

[systoly]

sorry folks, but simply re checking with the same glucometer makes no sense, unless

you suspect problems with the technique such as poor site preparation or drop size

given that one has verified the device has been properly calibrated, why would you use

the same device you suspect to have given a false reading

i don't disagree with getting a second reading per se, but why would you do the same exact thing

twice when you suspect something went wrong the first time

[jallen326]

It's policy at my facility to recheck the blood sugar if low or high and it even directs you to do do on the machine in case you have a mental lapse in judgement

[sadiemae1123]

Our hospital policy is to recheck abnormal highs or lows and if there is a difference of more than 15% to get a venous draw.