you can't reschedule insulin? computer charting

rita359 · Mar 1, 2012

I am not totally computer savy but I wouldn't reschedule insulin unless you can only reschedule one dose. I'd be afraid all doses would be rescheduled and that would not work. So let it late and add comment regarding being off floor for x amt of time. I think whether you give the ss insulin at 2pm is a judgement call. What has the blood sugar been running? your dose now is going to still be on board when next ss is due soooo if sugars are always high it won't hurt. Otherwise I'd hold it and let next bs be covered by ss. Guess technically with new thinking dr should be called but haven't seen that happen in my practice.

blondy2061h, MSN, RN · Mar 1, 2012

I would ask for a one time dose order when he came back on the unit.

Been there,done that, ASN, RN · Mar 1, 2012

Check hospital policy on this one. Some common sense is missing here.

Of course you need to reschedule the meds.

Try calling a doctor everytime you have to do this... you will drive the doctors and yourself crazy!

classicdame, MSN, EdD · Mar 1, 2012

Who are we treating - the patient or the computer??????

Some people are afraid to move outside the box. If you need to make a change, either call the MD or talk to charge nurse.

Altra, BSN, RN · Mar 1, 2012

I'm not sure that it matters much either way. Either you reschedule the one dose to be given "on time" and have to note the reason for the change, or you give the dose "late" with the note that the reason is that the patient was off the unit/unavailable/having a test or procedure performed. Get clarification from a unit educator, charge nurse or supervisor on which method is preferred ... and don't sweat it.

MN-Nurse, ASN, RN · Mar 1, 2012

I agree with the previous poster, take care of the patient, not the computer charting system. The insulin administration is being rescheduled regardless of what you do on the computer.

If you want to get yelled at, go ahead and call an MD and ask them for an order to change lunch time. ;-)

Some nurses leave the computer scheduling alone, others monkey around with the due times. Either is fine (as long as you don't inadvertently reschedule ALL the subsequent administrations.)

As far as insulin administration goes when the patient returns - it depends on too many other factors to be able to give you a direct answer. As a general rule, I error on the side caution, especially with patients I don't know very well.

As I get to know patients better, I get much better at tightening up their glucs.

beckster_01, BSN, RN · Mar 1, 2012

It drives me nuts when people let computers critically think for them.

For your case, I would let the medication be late. When the patient returns to the unit and orders lunch, I would recheck a BG, and give insulin as indicated. In the computer I would write a comment along the lines of "patient off the floor during lunch time, received a late tray." I wouldn't change the times unless he eats late every day. I think of it this way, what would this patient do if he were at home?

As far as messing with other med times goes, I have been known to change times for TID meds to better reflect a patient's home schedule. For example, I had a patient getting suboxone. The computer timed it for 0900, 1700, and 2300. The patient takes it at 0600, 1400, and 2200. You bet I changed it to his home schedule because, in his words, it makes him feel better. I don't care what the computer thinks If it is q8/q6 hour medication, I am a little more careful about how I time it, but try and time the medication so that I won't have to wake the patient up at 0200 for one pill, and 0400 for another. In short, don't be afraid to change medication times if it makes sense, and don't be afraid to give a medication late as long as there is sound reasoning behind it (and be sure to document!).

ckh23, BSN, RN · Mar 1, 2012

I could be wrong, but I don't read the post as a computer issue. I think it is more of a policy issue that the OP may not be aware about.

OP I would not go along with "someone told me". Look up your policy. At my facility I do not have to notify the doctor when meds are rescheduled because they are off the floor. As far as the insulin, what type of insulin are we talking about? For that situation I would just call the MD and ask either for a one time dose or hold until next dose. However if they came back at 1400 and they are due for their next dose at 1600 I would probably just wait and recheck BS at 1600.

blondy2061h, MSN, RN · Mar 2, 2012

If you want to get yelled at, go ahead and call an MD and ask them for an order to change lunch time. ;-)

I'm fairly sure you're replying to my suggestion to get a one time order for insulin. Let's have a brief pharmacology review if you think just giving the lunch time insulin 3 hours late (and 2 hours and 15 minutes before another scheduled dose) is a good idea. Regular insulin stays in your body about 6 hours, peaking around the 2-3 hour mark. Rapid insulin stays in your body about 3 hours, peaking at about 1 hour. Either way, if you're giving more insulin at 4:30pm when you just gave the "lunch" insulin at 2pm, at the 4:30 dose you're going to have more insulin left in your system than what was planned for when they ordered the insulin for 11:15am. Many prescribers would want a dose adjustment in this scenario, not just giving the same dose late. If you work with doctors that would yell about that, I'm sorry your work in an environment that allows that kind of behavior that compromises patient safety. I would have way less issue with giving other meds late, but insulin is a whole different ball game.

beckster_01, BSN, RN · Mar 2, 2012

At the same time, how many patients will eat dinner two hours after they've eaten lunch?

Well, I'm sure there are a few. But most of my patients, who may come back from dialysis at 2 with the tray waiting in their room, will wait until 7 or so to eat dinner. Why bother the doc for a one-time order when you have a perfectly good standing order for the situation? Maybe I would call the doctor if they did eat dinner fairly soon after lunch. Of course it all depends on the patient, situation, and unit policy.