Night shift giving breakfast insulins w/o tray

1. 
   I know this is nursing 101 here, but I just started a new job at which I've been told twice (by two different charge nurses) that night shift nurses give the breakfast insulins - even though the trays don't arrive until around 8 am. At my 7 am sign off report (nights leaves at 7:30) the oncoming nurse was a little huffy that I hadn't given a patient 2 units of Reguar insulin due AC breakfast. This patient also had 8 am meds due.
   
   Ever since nursing school I have ALWAYS brought the tray directly into the patient with the insulin, and would never dream of doing otherwise! Are other units having night shift do this, or is this just plain crazy???
2. 

   About findingmywayRN

   Joined: Jan '04; Posts: 116; Likes: 19
   Rehabilitation RN; from US
   Specialty: Physical Rehabilitation

   34 Comments

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3. 
   Oct 8, '07

   Joined: Apr '00; Posts: 24,611; Likes: 35,453

   if it's immediate-acting insulin and it's given at 6 am, then yes, it's dangerous...
   unless the noc nurse is giving a cup of juice w/it.
   our am insulins are given at 7:30-breakfast at 8.
   
   leslie
4. 
   Oct 8, '07

   Occupation: Rehabilitation RN Specialty: Physical Rehabilitation ; From: US ; Joined: Jan '04; Posts: 116; Likes: 19

   Thanks for your reply. My concern is - what if the trays are late, the patient gets sick or just doesn't want to eat? Wouldn't that put my licence on the line if the patient bottoms out?
5. 
   Oct 8, '07

   Joined: Apr '00; Posts: 24,611; Likes: 35,453

   i always make sure my insulin-dependent diabetics are up and about for breakfast.
   even if they want to sleep, i make sure they drink something.
   and if they're sick?
   their bs levels are higher anyway.
   
   leslie
6. 
   Oct 8, '07

   Occupation: Rehabilitation RN Specialty: Physical Rehabilitation ; From: US ; Joined: Jan '04; Posts: 116; Likes: 19

   I guess it's hard for me to do things differently. I think I'll be bringing mine in with something to drink, too. Thanks for your help Leslie!
7. 
   Oct 8, '07

   Occupation: R.N. Joined: May '07; Posts: 3,228; Likes: 3,680

   The problem I've had is we're told to do morning accuchecks between 5 and 6 am, then day shift uses that reading 2-3 hours later to cover the patients at breakfast. That concerns me, as the glucose levels obviously can change in the span of those hours.
8. 
   Oct 8, '07

   Occupation: major case manager Specialty: 27 year(s) of experience in icu, er, transplant, case management, ps ; Joined: Jul '07; Posts: 968; Likes: 549

   Quote from findingmywayRN

   Thanks for your reply. My concern is - what if the trays are late, the patient gets sick or just doesn't want to eat? Wouldn't that put my licence on the line if the patient bottoms out?

   Most Type 2's, who take insulin, know when they should receive it and the importance of eating, even when a patient in the hospital. I am surprised that the aptients are not objecting, I certainly would, if I were receiving regular insulin. And I am surprised that attending physicians are not objecting. If the patient is receiving regular insulin, he should know the importance of eating and/or drinking. Depending on how much he has received, if he vomited, I would notify the attending for advice. And chart what I did.
   
   Woody
9. 
   Oct 8, '07

   Joined: Jul '07; Posts: 84; Likes: 43

   I would check with your clinical specialist or the policy and procedure manual. I give the insulin after the breakfast tray has been given and the pt is eating. What if the person decides they don't want to eat? Or they are whisked away to a early am test without breakfast?
10. 
    Oct 8, '07

    Joined: Aug '06; Posts: 287; Likes: 51

    Quote from Emmanuel Goldstein

    The problem I've had is we're told to do morning accuchecks between 5 and 6 am, then day shift uses that reading 2-3 hours later to cover the patients at breakfast. That concerns me, as the glucose levels obviously can change in the span of those hours.

    This was happening at my hospital also. The endocrinologists were definitely not happy! Patients order their meals so they arrive at various times. It was eventually decided that the delivery person would hit the call light and the nurse would then check their blood sugar and treat.
11. 
    Oct 8, '07

    Occupation: ICU float, medical, surgical, cardiac and neuro Specialty: 12 year(s) of experience in Travel Nursing, ICU, tele, etc ; Joined: Jun '07; Posts: 1,792; Likes: 792

    I worked on a unit where the day shift wanted us to do check the blood sugars and give the insulin and as a shift across the board we REFUSED to do it. We couldn't in good conscience give the insulin, not knowing when they would actually end up eating. We felt it was a dangerous practice. Also, a few of the more conscientious day nurses didn't want us to adminster insulin to their patients either, without them having control over the situation and taking full responsibility for the accuracy etc.
    
    I like the idea of giving juice, but then you are waking the patient up making them drink juice, when they could possibly get another hour or so of sleep. I would hope that your management has the intelligence and foresight to see how idiotic this practice is. The day shift can squeeze it in to their busy schedule...I would say.
    (Perhaps they could shorten their morning break a bit.....)
    OK just kidding, day shifters, I know your shift is busy.....hehehe
12. 
    Oct 8, '07

    Joined: Nov '06; Posts: 20,715; Likes: 23,953

    Our fasting BGs are done at 0730, breakfast is at 0800.
    
    If I know the oncoming nurse is going to have a busy day and it is not too late, I will sometimes check it before I go, between 0700 and 0730.
    Most of the time, dayshift is ok with us leaving it for them, since it's well-known that fasting bgs are to be done at 0730. And I don't mind doing a 1hr postprandial when I first get there at 1930. P&Ps say it has to be done then, ok, I'll do it then. No biggie.
    
    ETA: I would NOT check a BG at 0600 and expect someone to give insulin based on my reading, nor would I give AM insulin at 0630 if there is no breakfast around. I have mamas and their babies....low bg for mom = potential bad baby outcome.

    Last edit by ElvishDNP on Oct 8, '07
13. 
    Oct 8, '07

    Occupation: FNP Specialty: FNP, peds, epilepsy, mgt., occ. med., ed ; Joined: Mar '02; Posts: 1,821; Likes: 1,564

    This sounds like a very task-oriented approach: just get the task done, whether it makes sense or not.
    
    Giving insulins with no breakfast tray in sight sounds like a very bad idea to me. As someone else said, a lot of things can happen: the patient goes off the floor for something, doesn't want to eat, doesn't get a tray for some reason, etc.
    
    Sounds like a disaster waiting to happen!
14. 
    Oct 8, '07

    Joined: Apr '00; Posts: 24,611; Likes: 35,453

    that's why i've made it priority to give a drink when doing a fingerstick.
    i don't have any control over the future, but i sure do at the time i'm doing the fs.
    so far, i've never had a pt who slept through this annoying procedure...
    and they all seem to welcome something cold to drink, no matter what the hour.
    
    leslie

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