Giving insulin late patient request

  1. 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?
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    About daniela095

    Joined: Feb '14; Posts: 19; Likes: 3

    17 Comments

  3. by   Newgradnurse17
    If it was their regular insulin, I would follow the pt request. They know there own condition better than me. But for sliding scale I would only give before meals, as charted This is obviously not the pt normal, so you needed to provide more education and informed them that they need to have it before meals. If they still don't want to have it I would discuss with the charge nurse and assessed there bgls.

    But no, I don't think you will get in trouble for this. Wouldn't do it again though. Clearly you knew it wasn't right to give it late. Humalog is quite fast acting, giving it after while after a meal isn't an effective way to manage there bgls.
  4. by   daniela095
    Hi, patient didn't eat yet when I gave it late she was just starting to eat. However it said to give anyway even if patient doesn't eat after the insulin. She was just a difficult patient and wanted it a little later.
  5. by   daniela095
    Humalog insulin 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. Didn't think I needed to adjust the rest of the scheduled times since her blood glucose always runs high. Could I get in trouble for giving insulin late if patient requested it?
  6. by   Triddin
    I'd be curious why the patient wants the insulin later and would adjust my glucomter check times to closer when the patient wants to have insulin. I'd hazard you shouldn't get in trouble as long as you document conversations with the patient as to why you gave late, but it does seem that people get in trouble for everything these days so who knows?
  7. by   EllaBella1
    I would have just charted that the patient refused earlier and agreed later. Covers you either way. I wouldn't have adjusted the times for the next insulin dose.
  8. by   KelRN215
    It sounds like that was the patient's morning/breakfast dose insulin and she wasn't planning on eating breakfast at 8am. I don't think requesting the breakfast dose when she's about to eat breakfast makes her a "difficult patient." That sounds perfectly reasonable.
  9. by   KelRN215
    Quote from daniela095
    Hi, patient didn't eat yet when I gave it late she was just starting to eat. However it said to give anyway even if patient doesn't eat after the insulin. She was just a difficult patient and wanted it a little later.
    Is the insulin based on her blood sugar value alone or blood sugar + the amount of carbs she's going to eat? If the latter, you definitely don't want to give her the dose if she's not going to eat.

    I have a type 1 diabetic 5 year old patient on my caseload. We teach his caregivers that he is to get his insulin within 15 minutes of eating.

    A lot of times, electronic medical systems have default times that they schedule meds for depending on how they're ordered. When I worked in the hospital, for example, a q am medication was automatically timed for 8am. If it was something the patient took at home and they told me that they took it regularly at 6am or not until 10am, I gave it at the time the patient requested and rescheduled it accordingly.
  10. by   cleback
    Quote from KelRN215
    It sounds like that was the patient's morning/breakfast dose insulin and she wasn't planning on eating breakfast at 8am. I don't think requesting the breakfast dose when she's about to eat breakfast makes her a "difficult patient." That sounds perfectly reasonable.
    Yep. And if this was the habit for her, I'd even see about changing the administration time to reflect her meal schedule.
  11. by   Silverdragon102
    threads merged
  12. by   Jedrnurse
    Humalog whether or not they eat?

    Say what?
  13. by   Accolay
    I would say that you wouldn't be in "trouble" per se. As others suggested, make sure you document and talk about it with your patent. Sometimes it's because they know their body. Other times it's because they have some magical thinking about their condition. Either way patients usually have free will even if we think something is the best course of action.

    Also depends on what the patient's blood sugar was. If it's like 160 and that's where they ride- ok whatever- not ideal, but it's gonna be ok- still talk with pt and document.

    But if it's like 300-500 and the pt continues to refuses after having a conversation, then find the MD to speak with the pt and document.
  14. by   SobreRN
    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.

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