Giving insulin late patient request

[daniela095]

Humalog insulin sliding scale ordered for patient before meals however it is to be given regardless of whether or not they eat. The patient requested not to have insulin at 8. She got the insulin at 10. Next dose of insulin at one and so forth. Could I get in trouble for giving insulin late if patient requested it?

[K9lover, ASN, RN]

As another posted I would mark earlier as refusal. You can bet if there is a bad outcome involving an attorney the patient will deny requesting later or say you should not have complied.

[sarsett]

Humalog whether or not they eat?

Say what?

Right??

[Ddestiny, BSN, RN]

If I understand correctly, it sounds like the patient was requesting the insulin be given in conjunction with her meals, which she was eating a couple hours late. Not everyone is an early eater. I'd just make sure that I'm checking the blood sugar right before she ate (at 10am, not 8am) then giving the insulin with her meal or immediately after.

At my facility our endocrinology staff don't have any problems with patients eating late (and thus getting their insulin late). They get concerned when insulin is being given over an hour after the BG was checked (and really they'd prefer it to be a much smaller timeframe but some people get both sliding scale and carb ratio -- necessitating that one waits until after the meal is complete -- and pretty much everyone gives them both at the same time). It's also important to make sure that there are several hours in between each administration of humalog, so if breakfast is late then lunch needs to be late too.

If I'm misunderstanding and she's eating at 0800 and not wanting insulin for another couple of hours then that'd be an education issue.

[adnrnstudent, ASN, RN]

Humalog whether or not they eat?

Say what?

If I'm reading it right, it's sliding scale, that's just correcting a high sugar so I totally get that, doesn't matter if they eat or not. Now if it was a scheduled 15 units then I would be curious if what I said above my edit is happening.

[daniela095]

Here are more details; I would like some more opinions please:

My patient had an order for sliding scale humalog 3 times a day before meals REGARDLESS of PO status. Meaning they can still get the insulin whether or not they are actually about to eat, but it would probably be ideal if they did eat I'm assuming. I had a patient who didn't want insulin at the scheduled 9 am time and wanted to be left alone for a while. I then re did the fingerstick at 10 and gave the insulin. However, I scanned the insulin late and put the reason as the patient requested. I am a bit paranoid from scanning the insulin late instead of marking refuse initially I do not want someone to see that as a problem if that's what the patient wanted considering I did re check the fingerstick. She had trouble taking quite a few other meds on time that I ended of rescheduling for later in the afternoon. I ended up writing a note at the end of the day explaining that she was having difficulty taking meds on time. Would this cover me for the late insulin and rescheduled meds? I am also on orientation.

[KelRN215, BSN, RN]

Here are more details; I would like some more opinions please:

My patient had an order for sliding scale humalog 3 times a day before meals REGARDLESS of PO status. Meaning they can still get the insulin whether or not they are actually about to eat, but it would probably be ideal if they did eat I'm assuming. I had a patient who didn't want insulin at the scheduled 9 am time and wanted to be left alone for a while. I then re did the fingerstick at 10 and gave the insulin. However, I scanned the insulin late and put the reason as the patient requested. I am a bit paranoid from scanning the insulin late instead of marking refuse initially I do not want someone to see that as a problem if that's what the patient wanted considering I did re check the fingerstick. She had trouble taking quite a few other meds on time that I ended of rescheduling for later in the afternoon. I ended up writing a note at the end of the day explaining that she was having difficulty taking meds on time. Would this cover me for the late insulin and rescheduled meds? I am also on orientation.

Who timed the insulin for 9am? It very well could have been an arbitrary time assigned by the computer system. You said the med was ordered TID- TID at my hospital was automatically scheduled for 8am-2pm-10pm but the patient's actual schedule may have been nothing like that. What is your facility's policy for medication administration windows? Many places have a policy of +/- 1 hr so there isn't even anything to justify if you give a 9am med at 10am.