How do you judge glucose monitoring?

[mitral]

Hello,I was wondering how you all determine who gets their blood sugar checked and how often. I would think all DM patients, and those on steroids. What about NPO DM, and so on? Every 4, AC/HS? How do you decide? Thanks!!

[LVN2RNMom, ASN, BSN, LVN]

Nurses are not the one's who decides this. The orders on glucose monitoring comes from a Dr, not a nurse.

[ChristineN, BSN, RN]

Nurses are not the one's who decides this. The orders on glucose monitoring comes from a Dr not a nurse.[/quote']

I agree there are generally doctor's orders for blood sugar monitoring and frequency. Some hospitals do have protocals so nurses don't need orders for all patients. General rule of thumb is anyone that is diabetic, on high dose steriods, newly started on TPN, or has insulin ordered should have scheduled accuchecks. Many ICU's also have their own orders and protocals for blood sugar monitoring, even for patients that aren't diabetic.

[Born_2BRN]

MD's order, not us nurses to determine. Unless MD missed information that patience is diabetic then a nurse can discuss with MD for new order.

[BrandonLPN, LPN]

Frequency is determined by the doctor. Of course, it's the privilege of the nurse to check PRN whenever he deems necessary.

[SaoirseRN]

Frequency is determined by the doctor. Of course it's the privilege of the nurse to check PRN whenever he deems necessary.[/quote']

This. Doctors determine how often they feel sugars should be checked, but it's within the nurses scope to do additional checks if they have observed a need to do so, and sometimes the patients will ask to be checked if they are feeling "off".

[KelRN215, BSN, RN]

Hello,I was wondering how you all determine who gets their blood sugar checked and how often. I would think all DM patients, and those on steroids. What about NPO DM, and so on? Every 4, AC/HS? How do you decide? Thanks!!

Based on the doctor's orders.

[classicdame, MSN, EdD]

mostly based on MD order, but OP raised good points. The nurse is monitoring the labs and should be able to spot irregularities in any lab, not just the ones the MD has ordered us to monitor. So report to MD if you have issues.

[nurseprnRN, BSN, RN]

It is generally in the medical plan of care. From a strictly procedural standpoint, generally the admission paperwork specifying the medical plan of care includes frequency of checks and sliding scale insulin coverage, further labs, and/or other intervention.

Since lay people are instructed to check their own blood sugars at the signs of hyper/hypoglycemia, it's not inappropriate for a nurse to put prn glucose checks in a nursing plan of care (based on acute assessment of need by an RN) outside of the scheduled, routine checks.