Having another nurse check insulin doses & other med Qs

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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.

Specializes in Cardiac Telemetry, ED.
Do most people here still Draw up insulin in an actual syringe?

I'm quite certain that would be a yes. Diabetes, oral agents, and insulin were covered very thoroughly in the nursing program that I graduated from, and rightly so. Diabetics make up a significant portion of the patient population in both acute care and LTC.

"Do most people here still Draw up insulin in an actual syringe?"

I assume this post refers to insulin pens.. Personally, if someone comes in with their own insulin pen I still draw the dose out with a syringe. Have seen too many high sugars after administration with a pen that my person conclusion is too many times the needle on the pen is not getting under the skin well enough. Just my opinion.

Maybe the needles weren't primed first.

I really hope you aren't giving the patients their pens back to be used as intended, because once you draw out of a pen cartridge with a needle, then it IS inaccurate because the plunger of the pen hasn't moved - there's most likely air left in the cartridge.

This seems somehow strange to me. I've been a nurse for over 30 years, and have always had to have a co-signature for insulin (sq) and heparin. now most facilities require it for quite a few other meds, strangely enough including po's-warfarin & tamoxifen (anti-coag + chemo, respectively).Yes, it's a pain. Then again, I was on shift when a nurse gave 20 units of reg insulin instead of 2.

I am an LPN and I worked in a long term care here in Edmonton, Alberta .I have 36 residents to give medications to and I have 5 residents with insulin and yes we have an RN who is covering 4 other units who will have to check with me everytime I withdraw the insulins. It's quite frustrating though to wait for a long time for the RN to come. While in my other facility, I also have 32 residents to give medications to and I have 4 residents with insulin but we're using the pen instead of the regular insulin syringe, so we don't have to ask the RN to check with us when giving the insulins.

Interesting, we have to check with the pens too. Lucky you! I'm so jealous!

I'm a block 1 student and we were taught that insulin and heparin are high alert drugs, meaning you do indeed have to ask another RN to double-check math, the MAR, and watch you draw it up. I also know that when administering opiods, if there's any left over you have to ask another RN to watch you waste it.

Specializes in ER.

We have to do this at our hospital, and it is a TOTAL waste of time. Not only do you have to find a cosigner for insulin, but for Heparin, coumadin, ivp narcotics.....it's getting a bit silly. It takes forever to track someone down, as we have "electronic med administration".....a computer on wheels that we have to drag up and down the hall with us to beg a coworker to sign in. Another one of those "super-duper great ideas" thought up by people who haven't passed meds in 20 years...if ever. They never stop to take into consideration how much extra time gets eaten up by their bright ideas..and just last week I got to write up 3 nurses, a PA, and a pharmacist for sending me a patient on a heparin gtt at 2.1 ml an hour-yep, the pt got 1/100 of the dose she should have...BUT, hey , it was all cosigned!!!!!:mad:

We have to do this at our hospital, and it is a TOTAL waste of time. Not only do you have to find a cosigner for insulin, but for Heparin, coumadin, ivp narcotics.....it's getting a bit silly. It takes forever to track someone down, as we have "electronic med administration".....a computer on wheels that we have to drag up and down the hall with us to beg a coworker to sign in. Another one of those "super-duper great ideas" thought up by people who haven't passed meds in 20 years...if ever. They never stop to take into consideration how much extra time gets eaten up by their bright ideas..and just last week I got to write up 3 nurses, a PA, and a pharmacist for sending me a patient on a heparin gtt at 2.1 ml an hour-yep, the pt got 1/100 of the dose she should have...BUT, hey , it was all cosigned!!!!!:mad:

don't you just LOVE having to push the cart into a pt room, scan the pt, then scan the med, then wander the halls trying to find someone to co-sign, then the computer times you out....so you have to go back & scan the pt & start all over again. Particularly frustrating with tamoxifen & coumadin po.

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