double-checking insulin with cokworker

NurseFirst · Mar 13, 2005

Does anyone here work at a hospital where there is not a policy r/t double-checking insulin? I know that there are some places where it's not policy, but the nurses do it anyway because of safety. I graduated last June and was hired with some other people from my class at the local hospital. Policy at our hospital is that insulin is to be double-checked by two RN's. Sometimes, doing the double-check feels like like a pain but I feel it's always better to be safe than sorry.
Well, I was hired to a med/surg unit with fellow new grad who I went to nursing school with. He's always been a cocky, confident, know-it-all individual, and it continues here at work on the floor. Whenever I ask him to check my insulin with me, he won't even look at the syringe that I've just drawn up, but he'll say, "Looks good" then walks off. If he's in the medication room getting his insulin ready while I'm in there, I'll offer to check it with him. He'll say, "I guess, if you want to", and that tells me he was planning to give the insulin without a double check. I've confronted him about it and he told me that double-checking insulin is "lame". He said that insulin is just like the meds we draw up for IV pushes, and we don't double-check those, so he feels that double checking insulin is a waste of time and he said he's skeptical about an extra unit or two of insulin causing real harm to the patient. I'm one of those "go-by-the-book" type of people, especially when I'm in "nurse-mode". I'm not a timid or nervous nurse, but I feel that if I follow the policy of the hospital and try my best, then the chances of something bad happening diminish greatly. I expect myself to do a good, safe job at work, and I expect the same from the team I work on. I feel that he's cutting corners and he's being a lazy. He just applied for a charge position on our unit, and he got it. I find that really scary, and I'm seriously considering applying for a postion on a different shift, because I don't think I could work under a charge nurse that I don't trust or respect as a safe practictioner.
So, all you more-experience nurses out there: Can getting an extra units of insulin be critical? Personally, I definitely think so. I also feel that giving the wrong type of insulin by accident because you didn't double check can also be big trouble. Or do I just sound like a fussy nurse?
How do you feel about my coworker's attitude? I'm afraid that this attitude of his is going to get him in a lot of trouble later. If you were in position, would you address any of this to the unit manager? How would you go about doing it? Remember, he just was granted a charge nurse postion, so I'm pretty sure the unit manager thinks highly of him.

I'm still a student, but I think the term you want is "standard of care". In a lawsuit the action of a defendant nurse (or other health practitioner, or even other professional) is compared to what a prudent practitioner would do. While I've heard that many folks don't double-check insulin dosages, if checking insulin with another student is what is taught and what is common practice, you are playing legal Russian roulette to do otherwise. I would check the policy & procedures manual at your hospital, as well.

We learned in school the 4 most dangerous drugs we can give by the

following mnemonic:

Did I Kill Him

for digoxin, insulin, potassium and heparin.

One of the problems in giving less or more units of insulin, or any other drug, is that others rely on the veracity of the amount of drug given and patient response in order to make judgments about further therapy. Does he get the air bubbles out of the insulin he draws up, or not? I mean, if he's not concerned about 1 unit more or less, then why bother getting out air bubbles?

By the way, I'm not sure (since I am still a student)--but don't some of the places where two people check, both sign off on the amount? Or am I thinking of just blood product administration?

NurseFirst

P.S., one way of addressing it, "sideways", is to ask the unit manager about the policies and procedures on double-checking insulin--you may want to start out with how you learned it at school, and is that the policy here? Then you might ask the manager what would be the proper way of handling it if you saw someone not doing this--or how the unit manager would handle it.

RN-PA, RN · Mar 13, 2005

We aren't required to have another nurse check insulin with us at my hospital. We do have to double-check and co-sign on blood products and PPN/TPN, and double-check on PCA and continuous epidural settings, and calculating/initiating a Heparin drip.

I will also say that your co-worker's attitude concerns me. Any nurse who is a "cocky, confident, know-it-all individual" as you stated concerns me and they may be headed for trouble (especially when their career is less than a year old). I'm not sure how I'd handle it with my nurse manager except to mention that "some" nurses aren't adhering to the insulin double-check protocol so that the manager can maybe issue a blanket warning to your unit. If your co-worker then wouldn't comply, I'd probably say something directly about him to the manager so she/he can address his attitude, ESPECIALLY if he's now going to be charge nurse. How do your co-workers feel about him?

mommatrauma, RN · Mar 13, 2005

I work in the ER now, but I know on our med-surg units it is not a policy to double check SQ insulin before giving it...however our ICU's policy as well as ours is to double check an IV insulin bolus prior to giving it. But to reflect on the person that is having co-workers non-compliance issues...if it is a policy and he is not following it...I wouldn't worry about getting him in trouble, that's his problem...he decided not to follow...he has to live with the consequences...and unfortunately sometimes in order for "cocky" new nurses or even cocky seasoned nurses to realize they don't know everything, they need to get knocked down a few pegs...Pt safety should come first every time...besides who's to say if he's that complacent about not following the rules what happens if he ends up giving to much he tries to take someone down with him saying that he checked it with so and so...So since obviously your approach with him didn't work, and now that he's moving into a charge role...I would at the very least mention the behavior to the manager...you don't have to mention names necessarily, and maybe the manager can make a blanket statement regarding people not following the policy...good luck!

Mulan · Mar 13, 2005

Well, let me relate a couple of things to you.

Years ago, a nurse came to me to double check her insulin, well guess what, she had a three cc syringe instead of an insulin syringe. This was an experienced RN.

Years ago, an LPN gave insulin to a pregnant patient who came in the day before for a routine c-section the next day, she was on a postpartum floor. Well the LPN gave insulin using a tb syringe, I think they said it was about 100 times more than she should have gotten. Patient was on frequent blood glucose checks all night long. The only way it was discovered was that another nurse was looking for an insulin syringe and the LPN said, there are syringes there, well, they were tb syringes.

Things happen. Even experienced nurses can have a brain farct.

barefootlady, ADN, RN · Mar 14, 2005

It's a common practice here to check insulins with another nurse. Even if we have to stop what we are doing, walk to the med room, and physically check the vial, syringe, and dose. Sounds complicated but we have been doing it for years. I know it has caught several mistakes in doseage and type.

Don't think I would like working with a nurse, any nurse, who would not follow policy on this, makes me wonder what other shortcuts they would take, and ones that are not in the best interest of the patient.

Fiona59 · Mar 14, 2005

We drew up our own insulins without a double check. (Only nurse on the unit during the night).

I'm still shaking my head over BScN nursing instructor who drew up her insulins in separate syringes instead of mixing them. Her students asked why she was doing it that way when on the med room wall there was a poster reminding everyone the correct way to do it and avoid contamination.....

Who wants or needs to be stuck twice??

KrisRNwannabe · Mar 14, 2005

as students we draw it up and then hand it to another student and ask them how many units are in it. we don't give it to them and say 33 units right? I think were we do clinicals now they are required to have some check. all other injectables come in pre-filled syringes.

jnette, ASN, EMT-I · Mar 14, 2005

While not "required" where I work, I always do nonetheless... hoping that my coworkers will follow suit if they see me doing this enough.

I know of one time that a mistake was made by a coworker several years ago and our patient had to be sent to the hospital... I was not yet a nurse, but that incident stuck in my mind and always will.

Better safe than sorry. Always.

BETSRN · Mar 14, 2005

Does anyone here work at a hospital where there is not a policy r/t double-checking insulin? I know that there are some places where it's not policy, but the nurses do it anyway because of safety. I graduated last June and was hired with some other people from my class at the local hospital. Policy at our hospital is that insulin is to be double-checked by two RN's. Sometimes, doing the double-check feels like like a pain but I feel it's always better to be safe than sorry.
Well, I was hired to a med/surg unit with fellow new grad who I went to nursing school with. He's always been a cocky, confident, know-it-all individual, and it continues here at work on the floor. Whenever I ask him to check my insulin with me, he won't even look at the syringe that I've just drawn up, but he'll say, "Looks good" then walks off. If he's in the medication room getting his insulin ready while I'm in there, I'll offer to check it with him. He'll say, "I guess, if you want to", and that tells me he was planning to give the insulin without a double check. I've confronted him about it and he told me that double-checking insulin is "lame". He said that insulin is just like the meds we draw up for IV pushes, and we don't double-check those, so he feels that double checking insulin is a waste of time and he said he's skeptical about an extra unit or two of insulin causing real harm to the patient. I'm one of those "go-by-the-book" type of people, especially when I'm in "nurse-mode". I'm not a timid or nervous nurse, but I feel that if I follow the policy of the hospital and try my best, then the chances of something bad happening diminish greatly. I expect myself to do a good, safe job at work, and I expect the same from the team I work on. I feel that he's cutting corners and he's being a lazy. He just applied for a charge position on our unit, and he got it. I find that really scary, and I'm seriously considering applying for a postion on a different shift, because I don't think I could work under a charge nurse that I don't trust or respect as a safe practictioner.
So, all you more-experience nurses out there: Can getting an extra units of insulin be critical? Personally, I definitely think so. I also feel that giving the wrong type of insulin by accident because you didn't double check can also be big trouble. Or do I just sound like a fussy nurse?
How do you feel about my coworker's attitude? I'm afraid that this attitude of his is going to get him in a lot of trouble later. If you were in position, would you address any of this to the unit manager? How would you go about doing it? Remember, he just was granted a charge nurse postion, so I'm pretty sure the unit manager thinks highly of him.

You ARE doing the right thing in checking insulin with two nurses. Your new grad co-worker sounds like an a$$. He is far too cocky for his own good. You might want to check your hospital's policy and see exactly what is written. If it is that two RN's are still supposed to check insulins, then this co-worker is NOT following policy and could be putting a brittle diabetic at risk. If he is out of line, I would go up the chain of command and speak with your nurse manager. He is practicing unsafely.

BETSRN · Mar 14, 2005

We drew up our own insulins without a double check. (Only nurse on the unit during the night).
I'm still shaking my head over BScN nursing instructor who drew up her insulins in separate syringes instead of mixing them. Her students asked why she was doing it that way when on the med room wall there was a poster reminding everyone the correct way to do it and avoid contamination.....
Who wants or needs to be stuck twice??

..................and we wonder why some students come out with sloppy skills?

capgirl · Mar 14, 2005

Back when I worked in LTC, it was the policy NOT EVER to mix insulins in the same syringe. Many residents did in fact get stuck twice. I don't know why this was the official policy, but as you know, behind every rule is a crazy story.

Such as, one very experienced nurse was giving a large dose of HEPARIN to a pt, but instead drew up and gave that same large dose of INSULIN. Pt was rushed to the ER and luckily was ok. The policy there did not change however after that incident.

In one of the hospitals I currently work in, the policy is to have all insulins double checked with another nurse. In the other hospital I work, it is not a policy to do that.