DKAs on the floor?

[JazzyRN]

I work in a NYC children's hospital per diem. In this hospital when a child comes in as a DKA on insulin drip with fluids and Q1 hr fingersticks, they are placed on the floor. A nurse will admit and care for this patient along with her 4 or 5 other patients. The DKA pt is very time consuming with all the fingersticks, labs, urine dips, titrating insulin and changing IVFs or rates every hour or two. I see this as being dangerous. All of the other hospitals I have worked, DKAs were in the ICU until transitioned off the insulin gtt.I was just wondering what others have experienced?

[Tweety, BSN, RN]

We don't have peds where I work, but adult DKA's are put in critical care, or the very least an intermediate unit where there are lower ratios, but most off critical care.

[SweetOldWorld, BSN, RN]

We take insulin drips on our med/surg floor (not peds) but the nurse usually takes 3 patients instead of 5. What you're describing doesn't sound safe.

[MayisontheWay]

Both hospitals I've worked at REQUIRE insulin gtt's to be in critical care only. Do you at least have an aide to help make sure the glucose checks get done every hour? I agree, that's dangerous.

[JazzyRN]

nope at this facility aides dont do fingersticks. yeah its scary because i have a feeling something bad is going to happen there. but management is unconcerned since they have been lucky this far to not have any sentinel events surrounding this issue.

[marilynmom, LPN, NP]

I work in the PICU of a large Children's Hospital and we get all the DKA in the PICU and only transfer to them to the floor when they are completely stable and off insulin drip.

I agree with you, that doesn't sound safe at all! Not to mention that is way to much work for one nurse with quite a few other patients to handle!

[MelBel]

I don't work peds, but we do get DKA on our floor. We aren't supposed to have anything more frequent than q2 fingersticks, but if someone comes up to us, the order is usually just changed instead of the patient being moved. On nights, this means the nurse will have this patient plus 6-8 others...not cool!

[MayisontheWay]

I don't work peds, but we do get DKA on our floor. We aren't supposed to have anything more frequent than q2 fingersticks, but if someone comes up to us, the order is usually just changed instead of the patient being moved. On nights, this means the nurse will have this patient plus 6-8 others...not cool!

With insulin gtt's?

[GrumpyRN63, ADN, RN]

I don't work peds, but we do get DKA on our floor. We aren't supposed to have anything more frequent than q2 fingersticks, but if someone comes up to us, the order is usually just changed instead of the patient being moved. On nights, this means the nurse will have this patient plus 6-8 others...not cool!

Same thing here, and no one takes acuity into the numbers, X nurses divided by Y patients:angryfire

[MelBel]

With insulin gtt's?

Yep, with insulin drips.

[MAISY, RN-ER, BSN, RN]

Don't have kids in my care, but I have had 3 adult DKA with Q hourly FS and insulin drips during one shift in ER along with two other patients. Horrible day, horrible night for oncoming nurse. No room in ICU.

Unbelievable that they would send a child to a floor with large patient to nurse ratio. Unsafe for patient, nurse and other patients. I am not sure I would accept that assignment with a full load. Too dangerous!

Maisy

[DayOhioRn]

I work on a Critical Care floor, adults mind you, but we do have DKA insulin gtt's. We have had 3 or 4 on the floor before. The nurses on my floor carry 3-4 but at night they can carry 5. We also have vents, and other drips. We havea our aides do either the odd or even hour accu checks, and as a team leader, I do not assign more than one drip to a nurse or aide. It just is not safe.

I agree that the nurse to patient ratio IS NOT safe, especially with a sensitive population such as a pediatric floor. I think that this issue needs to be discussed with your manager and her manager. There has to be a safe solution.

Good luck!