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Discussion

Dilemma

I supervise and work a floor in LTC. A patient of mine has cancer, and due to the location of his cancer, his blood glucose levels were "trending" down. We have orders to report BG below 70 to the MD.

I mentioned that I would be reporting this to the doctor during my offgoing report to the other nurse. She said she had noticed it also but has been covering up the BG by giving the patient orange juice and then retaking the BG; only documenting the second BG level in the record - because it is a "pain to call the doctor".

I have been struggling with this for a couple of days now, and have decided that I need to report this to MY supervisor. Am I missing some other step that I should do otherwise?

My intentions to reporting this is that if directly affects the patient, and he is my main concern.

Any thoughts?

Thank you in advance!

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    • Featured Replies

    Yeah that's pretty bad, I am surprised she admitted it to you. Since she did, could you try educating her on the matter first? Maybe to her she is not doing anything wrong. If she isn't receptive then I would report it anonymously.

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    Maybe if you are nervous to report it, you could leave a message for your ADON or DON and say "so and sos sugars are down a lot when I see him. Maybe we need to talk to the doctor."

    If someone is low ill give a protein/carb snack and recheck but I would document both blood sugars.

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    Since you are a supervisor and a nurse, I feel it is your responsibility to immediately tell the nurse that you feel it is unsafe and educate them why. If they respond poorly, tell them you are going to the next step. You are a nurse, this is part of your responsibility to the patient and as a supervisor, it is your responsibility to the staff to identify, intervene, and instruct.

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    I would clarify this with the doctor. Is the patient in an end-of-life type of situation? If yes, I would discuss this with the doctor. But yeah, bad on your coworker and their bogus blood sugars.

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    If pt is end-stage CA (comfort care), can you have the blood sugar d/c'd? This would definitely be a comfort issue, as I'm sure the pt does not like being poked on a daily basis. Just a thought

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    • Experts

    But if a simple OJ helps the glucose.....why expedite this patients passing if that is not their wish. DNR is not a do not treat...comfort care doesn't mean ignore the simple things and let them die. It is to make them comfortable and comply with their wishes.

    This nurse need to comply with the oirders as well. If she inslt calling about this what else isn't she complying with or on calling when she should.

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    I think this is horrible, because she didn't say "I do it because it makes the patient more comfortable," she said she did it because it was a pain in the neck to call the physician, i.e., to do her job. She is also guilty of falsifying records-- yes, since she didn't chart the first BG; you can lose your license for that.

    If she'll do it for a comfort-care terminal patient (and yes, I get that this patient hasn't been designated as such yet, but still, we do know), she'll do it for anyone. Hell, she probably DOES do it for anyone. This has to stop.

    Lots of choices here. Get the physician prescription changed for this patient, whatever. Tell the doc that the BGs are too low and perhaps s/he'd like to change the insulin dose. Have the BG checks stopped. Tell her since she has figured out when people's BGs are low and she has been "treating" them with OJ, then she is in charge of seeing this one gets his OJ at those same times (sarcasm here). Whatever. But this situation has to stop.

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