Help Me Relax - Did I DO Something Wrong?

RNPATL, DNP, RN · Aug 7, 2004

I work on a pediatric diabetic floor. I discharged a child tonight who is on NPH and Regular Insulin - a new onset diabetic.
After prescriptions had been given and ALL discharge paper work was signed, before walking out the door Mom wanted the kids's blood sugar checked. Mom checked it with the hospital's meter and it read 318. Kid was hungry and it was almost time for supper. So Mom administered dinner does of NPH and Regular; which was 3 units and 3 units. So, kid is allowed to eat in half hour after giving Insulin - Mom said they were going to go to McDonalds on the way home.
We do computer charting and the kid was discharged out of the computer and I never had a pre-defined order for that dose since that was what he was going home on. I forgot to put the blood sugar and Insulin the the diabetic flowsheet in the paper chart.
Appareantly Mom had called the doctor later tonight - work called me and asked me about the blood sugar and Insulin since they werent charted. I asked work if there was a problem, they said no, just that the Mom called the doctor - I am not sure about what exactly.
At any rate, I am FREAKING out!!! Did I do something terribly wrong, other than forgetting to chart? What if he comes back to the hospital to be admitted? Im afraid I am going to get in trouble.
Please relieve my anxiety...
Andrea

From the information you provided, it sounds like you did everything you were suppose to do, except the charting. Of course, the charting would have provided information about the actions you took in relationship to the patient and his BS. However, the patient was discharged and the mother had the insulin and the orders from the physician as to how to take the insulin. Plus - all the discharge teaching was completed and documented. Perhaps the mother called the physician to inquire about his BS and the physician contacted your floor to confirm the BS level. 318 is pretty high and maybe the physician just wanted to verify that the motehr was telling him the truth.

I would not be to worried about it .... the physician probably just wanted to clarify that the BS was indeed 318. Relax ... I am sure all is fine. :uhoh3:

meownsmile, BSN, RN · Aug 7, 2004

If the kid is new onset, mom is probly pretty nervous and is trying to check the BS to frequently without letting the insulin activate. She may have gotten home and checked the BS and found it to be even higher and called the doctor about giving another dose. Dont worry, if the teaching was done and charted, and you make sure you pick up the late chart entry next time you work you will be fine. The doctor is going to have one nervous nellie calling him quite a bit until she is comfortable with the situation. Mom sounds like she needs more education and reinforcement on juvenile diabetes.

Was the discharge order different than what they had been getting in hospital? I would think it should have been the same since they were there to get the insulin dose stabilized and education on their disease?

Victoriakem · Aug 20, 2004

Anyone can forget to chart something, but if a discharge form was used, in future, write down on that the blood sugar & what the mother said about taking the child to eat dinner after discharge. It's terrible to be worried about this while you are at home trying to relax (?) after working hard all day. Parents are forgetful, they have a lot on their minds anyway, & it's norrmal to forget what the nurse tells you. Always try to write discharge instructions down.

Victoriakem

I work on a pediatric diabetic floor. I discharged a child
tonight who is on NPH and Regular Insulin - a new onset diabetic.
After prescriptions had been given and ALL discharge paper work was signed, before walking out the door Mom wanted the kids's blood sugar checked. Mom checked it with the hospital's meter and it read 318. Kid was hungry and it was almost time for supper. So Mom administered dinner does of NPH and Regular; which was 3 units and 3 units. So, kid is allowed to eat in half hour after giving Insulin - Mom said they were going to go to McDonalds on the way home.
We do computer charting and the kid was discharged out of the computer and I never had a pre-defined order for that dose since that was what he was going home on. I forgot to put the blood sugar and Insulin the the diabetic flowsheet in the paper chart.
Appareantly Mom had called the doctor later tonight - work called me and asked me about the blood sugar and Insulin since they werent charted. I asked work if there was a problem, they said no, just that the Mom called the doctor - I am not sure about what exactly.
At any rate, I am FREAKING out!!! Did I do something terribly wrong, other than forgetting to chart? What if he comes back to the hospital to be admitted? Im afraid I am going to get in trouble.
Please relieve my anxiety...
Andrea

barefootlady, ADN, RN · Aug 21, 2004

While I agree that we are all human and apt to forget to chart things sometimes, I think you learned a very valuable lesson, not charted-not done. I hope you always take time in the future to chart all discharge instructions and care/meds given prior to patient leaving the facility. It may mean a few extra minutes to the shift but will save on the panic level later. The only thing I might have done differently, was call doctor with the high BS level just to insure he still wanted patient to leave at that time, he may have wanted insulin given, child to eat and be checked 2 hours later . Just a thought. Remember it is occurrances like this one that teaches us how to be great nurses. You are probably on that road right now. :balloons:

mattsmom81 · Aug 21, 2004

I agree...altho I'm not a pediatric nurse 318 is quite high and along with documenting this all and recommend followup tomorrow with doc, I probably would have called the PCP myself to report the high glucose to see if he wanted to change the sliding scale or what he specifically wanted to do. We live and learn...don't beat yourself up, nobody was hurt.