Did i handle this situation correctly???

[marielina85]

Im a fairly new lvn with about 6 months expierience working in ltc. Well i worked prn at a ltc facility.so wat happened is a pt had just come in yesterday evening so the am nurse asked me if i could get an order for the pts cpap machine so i called the md on call and got the order.then later on when i checked the pts bs it was at 168 and pt was scheduled 45 units of intermediate insulin and had a sliding scale apart from that which he was supp to get 3 units from his bs reading.pt asked me if he could only take 25 units of the intermediate since he was worried his bs would become low due to him have to take the 45 units and sliding scale.i told him i didnt have the power to give him the 25 units i had to follow mds orders.pt was concerned because he said he started feeling lightheaded at about 100ish bs so i told him id call the md and ask his opinion and see if hed give permisssion for the 25.well to make story short the md on call pretty much reamed me a new one.he said that he was not changing any orders that pt had to take order as is or nothing at all.he was pretty much a jerk.i understand he was upset cause i had called him about the order earlier but i feel he overreacted.did i handle the situation right or wat could i have done differently???

[gwendalynn]

That seems like a lot of insulin to give a person. You have every right, not to mention your nsg license, to question a MD.

[expltcrn]

You did the right thing by calling the MD. Yes the patient does have the right to refuse, agree/disagree with medical care/medications, etc. - especially when they are self-responsible. However, had you not called the MD (who unfortunately sounds like a a*****e) and simply followed the patient's request, you were jeopardizing your license. There are regulations in notifying the physician when you are unable to follow a doctor's order. If something had happened regardless of which direction it went, you'd have been the one to suffer for it.

Your other options would have been to follow your chain of command - Supervisor, Director of Nursing, then there is also the Medical Director of the SNF who the DON can call should the need arise.

One advise though for long-term diabetics who have self-managed their insulin for a long time - they usually know what their body can tolerate. I've have worked with many who if their blood sugar drops below 200, they go through the whole hypoglycemic symptoms. It presents a harder picture to manage after illness, hospitalization, new MD, change of MD, etc. But it always behooves you to listen to them and work in partnership with the MD to help the patient.

Sadly, with LTC staffing in recent days, noone hardly has time to do spend to do these extra steps.

[bubblymom373]

I think that you did the right thing calling the Md. Like Lesilie I too listen to my diabetics, especially if they are new to the facility. As for the Md, sadly he won't be the last one who will yell at you. Your patient had a concern and you were the patient's advocate, you did nothing wrong bringing it to the Md's attention.

[Ahhphoey]

I think you did the right thing. Like someone else said, this won't be the last time you get reamed by a doc because some of them are just like that for no apparent reason. I would not have given the 25 units and would have explained that the patient had a right to refuse, but I cannot just give half the dose. When it comes down to it, if God forbid something happened with this patient that ended up in court, your facility would not back you because you would have been guilty of prescribing which is out of your scope of practice.

I also listen to my patients and may fully trust they know how to adjust their meds at home, however, when in a facility and under my care, I need to provide care within my scope of practice or risk losing my license. And I don't think documenting that the patient refused half the dose would suffice.