Having another nurse check insulin doses & other med Qs

Nurses General Nursing

Published

There is talk going around work that management is thinking about requiring nurses to have another nurse double-check insulin doses, meaning another nurse would have to watch one draw it up, and sign that it's the correct insulin and dose. I'm assuming this is another check to prevent med errors.

I've heard about this happening at some hospitals, but this is LTC, where we have up to 30 residents. Plus, some nurses have had up to 9 fingersticks to do. If this becomes an actual rule, med passes are going to take even longer. I can't imagine trying to track down a nurse for 9 fingersticks. :uhoh3: Do you have this rule at your job?

If this rule is done for safety reasons, then why not have a second nurse around for other "risky" drugs, such as narcotic pain meds and coumadin?

Another question: some residents have orders for narcotic gels, such as Ativan, that are to be applied to different hairless areas of the body. I'm curious: should the nurse clean the particular area of the body before applying the gel, such as the inner wrist? The instructions don't mention anything about washing the area before applicaton.

In addition, would the drug would lose potency if it was applied to the left inner wrist twice a day without washing that area between applications? I wanted to apply it on the upper back, just to rotate sites, and a nurse said it should only be on the wrists. I thought that as long as the area doesn't have hair, it's okay to apply the gel there. Am I wrong? Thanks.

Thanks to everyone who responded.

As I work in LTC, I have 30 residents to pass meds to, and there isn't always another nurse nearby to double check. On my shift, 3 to 11, we don't have any supervisors/managers around, plus the other med nurse is usually way down the other hallway, busy with her own med pass. It would be hard to find her for each of the 7 to 9 (I vary hallways) fingersticks I have to get, plus it would add quite a bit of time to my already hectic med pass. Sorry, but unless they hire more nurses to help out, I hope this 'talk' about the double check is just that.

Specializes in Hospital Education Coordinator.

Insulin is in the class of meds with the highest medication error. Double-checking doses is not part of our policy, but is part of our culture. Everyone does it to protect themself. A little bit of insulin goes a long way and when you are tired, dots and dashes on a syringe can be confusing. But in a LTC setting, is there always another nurse available? That would be the issue for me. I think Sethmctenn had the best answer about patches.

Specializes in Oncology.

We have to double check insulin, but all the nurses treat it as a joke and just sign off on whoever. I can't remember the last time someone actually looked at any insulin given. I know, bad, but true. Subq insulin (but not insulin drips, go figure), chemotherapy, and blood products are the only things we need to double check. Luckily, people do take the chemo and blood products seriously. The insulin is just silly in my opinion. As many others have said, I do much more dangerous things without anyone every checking everyday.

Sometimes I am the only nurse in my LTC and I might have up to 15 or so diabetics. Double check isn't going to happen. Sorry. Also..it is done at the med cart that is normally pushed down one hall. If there is another nurse in the building..she might be down another hall or on a different floor pushing her own med cart doing her own 10 or so accuchecks.

This might work in a hospital setting.

Specializes in Med/Surg/Tele/Onc.

I've been a nurse for 16 months on a Med/surg floor, so I realize my experience is limited. Sometimes a nurse (usually from another floor) asks me to double check her insulin. My floor doesn't do it. I'm not sure if it is policy or not. But they hold up a syringe and say, "how much". I'll say "5" or whatever. They say great. To me this is a joke. I haven't seen the BS, or the order, or the sliding scale, et. I don't know if they have Lantus, Novolog, 75/25, or heparin for that matter!. All I'm verifying is that there are 5 units of whatever in that syringe. Pointless and a waste of time. Someone already stated the only real way to truly check off the insulin would be to do it like we do blood or chemo. Check the order, check the dosage and route, check the patient's armband, etc. Certainly not practical when you have 6 insulins to give with the meal trays on the floor.

Specializes in Med/Surg.

I'm surprised at the number of people who have said they don't double check insulin drips....insulin is a high alert med, no matter what form it's given in, and we double check those, too. We check and sign off subq insulin as well, and we really DO look at the actual order, and what's drawn up.

Specializes in Geriatrics.

We have to get a second signature on any sliding scale insulin but are not required to do so for Lantus. Of course its to reduce errors but its a necessary evil and I am glad the nurse I normally have to track down checks mine just as I check hers.(yeah a huge pain as we do have up to 30 residents to pass meds on and have to take the page out of the book, take the syringe, the bottle of insulin etc) Sometimes I do them all at once and take them all with me, I have even put tape on the syringe with the persons name so I dont confuse them.. talk about time! ... I know there are some nurses at our facility that sign for each other but dont check, sorry not my policy- worked to hard to get this far!.

You know how long administration takes to implement things, well maybe not all but from where I have stood lots of talk goes on and little action is taken unless its state mandated or something of the sort..

Specializes in ER.

Insulin double checks began back in the old days when they had beef insulins, pork insulins, plus human, and each of those had the long acting/shortacting/midacting types, and then each of THOSE had 40u/ml concentrations or 60u/ml, or 100u/ml, and you had to pair the correct syringe (in units per ml) with the right insulin, and only then would you be looking at the number of units drawn up in the syringe. It was a damned complicated business. Especially when you factor in "rainbow coverage" which was a sliding scale based on a glucose strip that would change color to reflect how much or how little the blood sugar was. No machines that spit out a number. You had to stick the pt, put the blood on the paper, wait so many seconds, wipe off the blood, wait so many seconds again, then read the strip within a certain amount of time or start from the beginning.

In nursing school a diabetic patient was enough to enduce a nervous breakdown the night before. You were certain to get a 30min verbal quizzing before breakfasts were out. Even seasoned nurses took their time matching pt to insulin, to syringe, to correct type/concentration of med. Right now you've got the glucoscan that spits out a number, easy as pie, all insulins are 100u/ml-you could use just a 1ml syringe to measure.

I think the time when insulin was the most complex drug is long past. Down with (mandated) double checks!

Specializes in Med/Surg/Tele/Onc.

That's fascinating, Canoehead! And makes sense. Thanks for sharing. I didn't know how complicated the insulin regime used to be.

Specializes in Med/surg, telemetry, ICU.

I work in a hospital, and we have to get second signature for insulin. The problem is that now that all the documentation is done on the computers, it is much more time consuming. It is no longer just checking the type of insulin, looking at the syringe and signing on the paper. Now we have to scan the patient armband, scan the med, type in blood sugar result, source, units given, click a number of times to submit, type in password, then the other nurse puts in her user name and password. Quite a process. And if you have a bunch of people on insulin, it becomes time consuming. I loved paper MAR, was so much faster.

Specializes in ED, Med-Surg, Psych, Oncology, Hospice.
I work in a hospital, and we have to get second signature for insulin. The problem is that now that all the documentation is done on the computers, it is much more time consuming. It is no longer just checking the type of insulin, looking at the syringe and signing on the paper. Now we have to scan the patient armband, scan the med, type in blood sugar result, source, units given, click a number of times to submit, type in password, then the other nurse puts in her user name and password. Quite a process. And if you have a bunch of people on insulin, it becomes time consuming. I loved paper MAR, was so much faster.

This is pretty much our procedure for ALL isulins, lovenox, heparin, and coumadin. It's just something we do. All the other nurses are in the general vicinity getting their own meds so there is someone available. It's a requirement, it's a safety measure and it's just not possible to administer that med without doing it.

I really don't understand the complaints about double checking insulin. I understand it's time consuming, but it's a necessary evil. I'm just now trying to go to nursing school, but have worked in the hospital as a pharmacy tech. I can't even describe how many times nurses have given novolin instead of novolog, mixed sliding scales, just gave the wrong dose, etc. and our hospital "double checked". When we made TPNs and drips, we had to be more careful with insulin than almost anything else. It's just one of those things that gets mixed up and messed up constantly...

+ Add a Comment