Co-sign Insulin?

[FireStarterRN]

Here, we still co-sign insulin. When I worked in a nursing home years ago, we weren't required to. I can give many critical and potentially dangerous meds, including managing an insulin drip, without co-signing but we are still required to co-sign insulin for regular administration.

Sometimes it is terribly inconvenient to hunt down another nurse to give insulin. And, it seems silly. Maybe we should start co-signing all our meds? After all, we might make a mistake.

[lsyorke, RN]

Never had insulin co signed in 24 years as a nurse.

[cardiacRN2006, ADN, RN]

Subq insulin? Never co-signed for that. However, at the last hospital where I worked, we did have to have a co-signer for IV insulin and/or setting an insulin gtt.

Funny, we have to co-sign insulin SQ, but don't have to sign with insulin gtts.

[General E. Speaking, RN, RN]

I am all for safety. However, just once I would like to see something that would benefit the nurses (time-wise). Like patient med boxes in the patient rooms filled by pharmacy or a pharmacist on site 24 hrs/day.

It is getting harder and harder to get the meds out within the allowed time frame. Factor in less ancillary staff. Add the never ending customer service hoops that we now have to jump through. "Is there anything more I can do for you? I have the time". Plus the increasing acuity of our patients with numerous comorbidities that have 4-5 doctors for every body system imaginable writing numerous med change orders throughout the twelve hour shift. This amounts to 4-5 pages of meds for each patient. Not to mention the overbearing family members who critique your every move and ask you a million times when the doctor is coming only to switch to asking you a million times when the tests are going to get done that the doctor just ordered.

I am so very weary of a non-nursing person adding "just one more thing" for us to do. You can hardly take care of the patients anymore. Realistically, to accomplish everything (teaching, meds, assessments, baths, meals, listening, safety, discharge instructions, vaccines, etc...), we should be taking care of no more than three patients a piece.

[IndySkies]

This trend of co-signing insulin, (and enoxaparin), seems to have taken off in the last couple of years. I've always thought it was JACHO driven. I seem to remember reading one of their information phamphlets that the number one med error was incorrect insulin dosages. However, I have been a nurse for 30 years and have given and titrated many critical medications. We are professional, and highly trained are we not? Are physicians required to have another physician double check their orders, techniquies, or procedures? I think not.

We all know it is our life, career, etc., on the line when we care for our patients...These rules seem to evolve in the fabled ivory tower of unrealistic expectations and take vaulable time away from patient care.

[FireStarterRN, BSN, RN]

This isn't a new trend here, I learned it in nursing school 15 years ago. I've talked to a nurse from NY who never did it there, it must be regional.

[bigsyis]

I never worked anywhere that you had to cosign to administer insulin, but it was required that someone always check dosages wtih you, even in TPN. Like some other posters, I was always thankful for the opportunity to verify any potentially life-threatening drugs, signature required, or not.

[Virgo_RN, BSN, RN]

Yes, it is a pain in the butt to wander around trying to find someone to sign your MAR. Especially on Med Surg where 5 out of 6 patients can be diabetic and are on ac/hs fingersticks. This amounts to a lot of wandering in 12 hrs.

Factor in all the wandering for other reasons, like searching for equipment. I think we spend far too much time wandering. I thing there is a good reason for having insulin double checked, but there has got to be a better way.

[suzanne4, RN]

I never worked anywhere that you had to cosign to administer insulin, but it was required that someone always check dosages wtih you, even in TPN. Like some other posters, I was always thankful for the opportunity to verify any potentially life-threatening drugs, signature required, or not.

There is no way to document or prove that someone else observed your syringe if their signature is not documented someplace.

I have done this throughout my career, which is probably longer in terms of years than some of your ages, and it just has never been an issue. And I would continue to do it even a facility did not, but have never worked for one that did not. I feel more comfortable with it. And there are more and more insulins coming out now, not just the U-40 and U-100 that was either a pork derivative or beef derivative; it actually made from the linings of intestine in the old days. One mix up and it can be devastating for your patient, and that is what should be on the top of your head. And to just add to this, I have always worked in a critical care environment and titrate drips all of the time.

People seem to me more careful with the pumps and the pumps also act as a verified with you. But we are seeing a shift to more double signatures on things for added safety, both for you and your license, as well as the patient. It really does not add any time into things, especially if you have always been used to doing it.

[sleepyndopey]

:uhoh3:I hate to say this, please don't flame me:chair:.... but I kinda like the idea of having another nurse sign off on all meds. Handwritten MARS, medex's, poor MD handwriting on orders, drug packaging problems (neonatal heparin) and worsteing eyesight of us old nurses really make me want to ask someone else to double check on what I am giving.

I am an experienced nurse and there are some coworkers that may think I lack confidence or ability - I don't care - I HATE MAKING MED ERRORS:nono:. I would hate to think of a new nurse not wanting to double check a med (any med) because other nurses may criticize them for it.

I'm flaming you. Not because of your feeling on the insulin topic. It's because you said you were old! Hello! If your old, I'm old.

[meandragonbrett]

We co-sign insulin.....but critical meds such as dopamine, dobutmine, vasopressin, neo, epi, norepi, etc. don't need their calculations double checked... Sounds backwards if you ask me.

[NurseCard, ADN]

We have to have a co-sign on insulin administration, heparin drips, PCA pumps whenever we put in a new syringe or change a syringe.... and I'm sure there are plenty of other meds that I don't give that require a co signer. High alert meds that are given in the unit, in labor and delivery, etc...

I personally think it's a pain in the butt, but probably a good idea.

[morte, LPN, LVN]

if the co signer doesnt see you give the insulin, what is the point?..i have worked in places were there was no other nurse to check.....what then?