giving half a dose

[coletanner]

I have a question to ask you guys regarding giving half a dose of medication. Patient is on dialysis and is also diabetic. Patient blood sugar was 250. Patient has order for 20 units of levimir plus sliding scale insulin. Patient is alert and orientedx3. Patient husband was also at bedside. Came in to informed patient that her blood sugar was 250 and that she needs 20 units of levimir and sliding scale insulin (6 units). This is the first day I have this patient. Patient refused her sliding scale and only wanted half of her levimir. Patient husband agrees. They told me her blood sugar drops after dialysis. patient also told me she hasn't been eating very well including her diabetic snacks. I check her trends over a few days and what they are telling me is true. It even drop to 40 at one time. Patient is very much alert. I notify the supervisor and then gave half of the levimir per patient request. I then sent a message to the doctor in the morning as I did'nt want to wake him up at night. patient blood sugar in the morning was 185. Thats without the sliding scale coverage and only half of the levimir. So the patient knows more about her progress.

A morning nurse told me its either you give it all or none. At my previous facility we were allow to do this as long as there is a trend of result. I'm a little worry now. I also look back on the patients chart and she has been refusing the levimir on certain occasions and the blood sugar goes up to the 350s and higher.

[TheCommuter, BSN, RN]

Deciding to administer half a dose is not within our scope of practice as nurses. Either you give what was ordered or you hold the dose entirely.

If you or the patient feel more comfortable giving half the dose, you must call the physician and allow him/her to make that clinical decision. If the physician approves the reduced dosage, you are now covered by a physician's order.

However, deciding to give only 10 units of Levemir when 20 units was ordered is basically practicing medicine without a license. You cannot make that judgment call on your own. Call the doctor next time you want to give half a dose.

Patients can play with their dosages at home, although they are not supposed to. However, nurses are held to a higher standard of care and can be subject to disciplinary action for fooling around with dosages that were not ordered.

[BSNbeauty, BSN, RN]

Well said commuter!!!!

[Pangea Reunited, ASN, RN]

Some places have protocols for adjusting insulin. My current workplace specifies a half dose of some insulins for NPO patients, for example. At another place I worked, doses were commonly adjusted down (often at the patient's request and without an order). It may not have been legally correct, but it was the workplace culture and acceptable to the nursing supervisors as well as the rounding MDs. The dose actually given was always documented, of course. In some cases, an order was obtained after the fact (usually for future doses), but not in every case.

It's probably not something you want to continue to do, but your facility may or may not see it as significant.

[morte, LPN, LVN]

need to discuss with doc.

[RUmedic]

"The commuter" said it well. Just to add to it, there are some facilities that have policies outlining very conservative DM management. The hospital I had my clinical rotation at would have insulin dosages rounded down depending on provider's order.

An order from physician must be obtained for any dosage adjustments at all times.

[TheCommuter, BSN, RN]

Thread has been moved to our Patient Medications forum to elicit more replies and feedback on this topic.

[RNdynamic]

Deciding to administer half a dose is not within our scope of practice as nurses. Either you give what was ordered or you hold the dose entirely.

If you or the patient feel more comfortable giving half the dose, you must call the physician and allow him/her to make that clinical decision. If the physician approves the reduced dosage, you are now covered by a physician's order.

However, deciding to give only 10 units of Levemir when 20 units was ordered is basically practicing medicine without a license. You cannot make that judgment call on your own. Call the doctor next time you want to give half a dose.

Patients can play with their dosages at home, although they are not supposed to. However, nurses are held to a higher standard of care and can be subject to disciplinary action for fooling around with dosages that were not ordered.

I don't completely agree with this. With insulin its different but other meds, I don't see an issue giving a half dose.

Example: a patient c/o headache asks for tylenol. The doctor writes for 650mg tylenol PRN. You bring it to the patient and the patient says "I just want one tablet. If my headache gets worse I'll take the other one later." Honestly, I'd be completely okay with that, give them the tablet, and document in the MAR that pt wished to only have one tablet.

Would you really say to the patient that they have to take both or none at all? Or waste time calling the doctor and asking if its ok to give them just one tablet? Most doctors I know would laugh at you for doing that.