Do you have a blood glucose meter in your office?

[ohiobobcat]

Do you keep a stock blood glucose meter in your office? What brand? How do you stock test strips?

I had a non-diabetic student pass out the other day. By the time I got to the student he was awake and talking and vitals were stable, so I didn't call EMS. Parents were reached and student was taken directly to the ER via private vehicle.

I heard through the grapevine that doctor who ended up caring for this student was wondering why I didn't check a blood glucose. I have a bunch of glucose meters in my office from the previous school nurse. I'm guessing they were company samples, and all the testing strips have expired. Testing strips are expensive, and I don't think I can justify the cost of spending $50+ on a container of test strips that I MIGHT use 2x per year if I am lucky. Especially since I have to throw them away 30 days after I open them.

[CrunchRN, ADN, RN]

I have one from Bayer that I use for studies. They provided it after I got in touch. It is their one for use in multiple patients (they have both types), and the requirement for QC checks is only with a new bottle of strips.

[JenTheSchoolRN, BSN, RN]

While I think having a backup is a good idea, it seems that the parent of any child who would need to have his/her blood glucose checked, should provide their own glucometer to be kept in the nurse's office...

Oh, they do, but sometimes you don't realize you are out of test strips until you are out of test strips! (And even when you let parents know you are almost out, they still forget.) And they are so specific to each model. I also have a non-compliant kid that likes to "forget" her meter at home...

And I only test my diabetic students - I have a doctor's order for fingerstick and the student does the fingerstick him/herself (unless they are unconscious, of course). If I have an order for a non-diabetic kid, sure, but not unless I do.

[Wave Watcher]

We do not have a multi-use glucose meter in our district. A policy has never been written so we have not been able to use one. I would like to have one on the days my diabetics forget theirs at home.

[ohiobobcat]

I never thought about needing an order and consent to do a blood sugar on a non-diabetic student. I actually had another student almost pass out yesterday (must be in the water ) and thought about the blood sugar thing while I was treating this student. He did report eating lunch. I guess that's the best I can do for now until I explore this further for non-diabetics.

I have 12 diabetic students in my school, and it would be nice to have a back-up meter for them "just in case".

I will check with the the district physician and other nurses in the district, too. They have all been here for years, and this is only my second year as a school nurse (I came from the ER where we had standing orders and protocols for everything!!). Thanks for all of your responses!! :)

[gzussu]

I don't think that fingerstick should be considered invasive. Yeah, it draws blood but its not as if we are cutting anything completely open. Insulin dependent people stick themselves all the time. I think its a bit extreme to consider a fingerstick "invasive". It's a prick. It's a tiny little stub of a needle that unless a person is a hemophiliac or on blood thinners, won't really mean a thing. Yes, it could introduce infections, etc, but we've gotta use nursing judgment and weigh the cons and pros, here. If a kid faints...MAYBE its cuz his/her blood sugar was low. It can happen. It has happened.

A syncopal episode I would think should warrant a fingerstick. Perhaps the child didn't eat breakfast and she or he is stressed out or anxious about something.

Under such circumstances, fingersticks should be considered vital sign.

[Spidey's mom, ADN, BSN, RN]

Only the diabetic students have blood glucose monitors.

[Jolie, BSN]

It would be interesting to see what various district policies are regarding obtaining fingerstick blood glucose readings at the nurse's discretion. A few questions:

Is it within the scope of practice of the RN or LPN to do fingerstick blood testing on students with no identified health conditions or care plan?

Is there a FT nurse in every building? If not, would fingerstick blood glucose be done only by the nurse, or would other personnel be trained to determine when one is needed, and also how to perform one? Might this lead to a different standard of care depending upon whether or not a nurse is present?

What will you do with the reading you obtain? What will your normal range be? What will you do in the event of an abnormally low level? Will you administer glucose to an unconscious student? If so, how? What would your actions be with an abnormally high level?

Of those who state that they have a meter in their offices, how were they obtained? Are they "sanctioned" by the school? Do you have a policy and procedure for their use? Are they properly maintained with functioning batteries and in-date test strips?

For those who would like to have one, how do you plan to maintain your meter and ensure that adequate supplies are on hand and in date?

Can you tell that I think this is a bad idea? :)

[Spidey's mom, ADN, BSN, RN]

Gosh Jolie . . .you read my mind. Great questions!

[amoLucia]

I wonder if the word got out that you had a glucometer, a bunch of hypochondriac staff would be stopping in for a checkup?

From the sounds of some of you guys' stories, some staff try to use you as their freebie clinic.

You have my admiration for this specialty - some of the stuff you guys bring up, I would never have thought of in a million years!

[JenTheSchoolRN, BSN, RN]

It would be interesting to see what various district policies are regarding obtaining fingerstick blood glucose readings at the nurse's discretion. A few questions:

Is it within the scope of practice of the RN or LPN to do fingerstick blood testing on students with no identified health conditions or care plan?

Is there a FT nurse in every building? If not, would fingerstick blood glucose be done only by the nurse, or would other personnel be trained to determine when one is needed, and also how to perform one? Might this lead to a different standard of care depending upon whether or not a nurse is present?

What will you do with the reading you obtain? What will your normal range be? What will you do in the event of an abnormally low level? Will you administer glucose to an unconscious student? If so, how? What would your actions be with an abnormally high level?

Of those who state that they have a meter in their offices, how were they obtained? Are they "sanctioned" by the school? Do you have a policy and procedure for their use? Are they properly maintained with functioning batteries and in-date test strips?

For those who would like to have one, how do you plan to maintain your meter and ensure that adequate supplies are on hand and in date?

Can you tell that I think this is a bad idea? :)

I answered some of these questions previously, but I budgeted for my extra meter, I add it test strips to my budget, and I maintain and calibrate the machine. I presented its need to my boss and it was approved given the number of diabetes we have. Do I use it with non-diabetic kids? Nope. It is a back-up for my diabetic kids that run out of strips/forget meters. I works with teens that the plan is they carry their own glucometers. But they rebel by "leaving" their meters at home. I whip mine out and we check and document. They learn that "leaving" their glucometer at home doesn't get them out of BG checks and in turn, they start bringing their glucometer to school!

Yes, I do have some testers in my office - back-up of a back-up that each student provides. Sometimes that is great, sometimes not if that tester isn't working.

I also have diabetic trained personnel (DTP); they can assist with BG checks, insulin, glucagon. Currently two teachers, expanding it out a bit more. I trained them in case I am ever out of the building/after school and one of my diabetics needs help. This is ONLY for students with diabetes and in conjunction with each parent and each student's 504 plan.

Non-diabetic student needing BG check? Never done it, wouldn't do it unless it came with a doctor's order. If I suspected low blood glucose issues on a non-diabetic student, I'd be recommending follow-up to the parent instead so the student's doctor can call for testing.

[Flare, ASN, BSN]

my meter has the same audience - students that are already known diabetics that forget their meters or run out of strips (or once in a blue moon for me to check when their meter seems to be acting oddly (or to try to get a number when they are reading "hi")ect) I have allowed staff members that have been diabetic to use it on occasion that are diabetic for similar reasons. I figure it this way - yes - it is for the students, but you get 50 strips that will expire before i'm going to use them all so what's the big deal if once a year i have a staff member ask to check their blood sugar. The shelf life of my strips is 3 years and I have a meter that doesn't require that i code it.

[Spidey's mom, ADN, BSN, RN]

My first thought after reading the last two posts was I don't want to rescue the kids who forget their meters. We do a check every morning of the student's supplies and if they don't have it, parents/guardians are called.

I realize in a bigger school this might not work - I only have 4 diabetic students. One in 3rd grade and the other 3 in high school.