I am the only nurse getting high blood glucose numbers

Specialties Geriatric

Published

Okay guys. I am a 48yr old new nurse...hired by a LTC that I like. I DO KNOW HOW to take blood glucose ... so that is NOT the problem. I am 2nd shift and have a pt who has DR order to call him if BS is above 400. I do accu-check before supper around, say 430pm. The last three times I have worked, and done the check, I have gotten counts OFF THE charts..in high 400's and once even not countable on the monitor. Protocol is to call Dr. and family...adminster as perscribed...chart, recheck in two hours...chart...and fill out lots of paperwork. When I called the Dr second time he seemed surprised. The family asked if "what are you feeding him". I even recheck when they are that high. I think the nurses that I work with are accountable and professional...but why am I the only one to get high counts.../ Hmmmmm...help!

Be careful before you jump to the conclusion that the other nurses are making numbers up. It could be a million things. Maybe your technique differs. Maybe you work on days where the residents have snack filled activities. Maybe it's just a coincidence. Maybe the other nurses check later than you do and the residents have burned off more sugar by the time the other nurses check.

Bringing this "issue" (there is no issue) to your manager would be a huge mistake.

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Why don't you just have the doc order an A1C and see if his glucose is consistently high

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

After having worked in several LTC facilities over the course of six years, I have encountered a handful of nurses who do not call the physician with glucometer readings that exceed 400mg/dL as a time saving measure.

They'll document the blood glucose as 399mg/dL, 380mg/dL, or some other number that falls just below the 400mg/dL radar, and they'll administer sliding scale insulin as if the result fell between 351 to 400mg/dL.

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Specializes in hospice.

We need clarification here. OP, are you in fact wiping away the first blood droplet with an alcohol pad?

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Specializes in ICU.

What type of glucose control medication is the patient on? Is he getting a longer-acting insulin that maybe has reached it's peak before your shift begins? What time is lunch served? Are the dayshift nurses getting lower numbers because he has not eaten all night? I agree that it is probably just coincidence.

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Wait, do I understand some of you are saying it is common practice to wipe away the first blood drop? Is this the US practice? In Australia I've never gotten rid of the first drop when taking a BSL.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Wait, do I understand some of you are saying it is common practice to wipe away the first blood drop? Is this the US practice? In Australia I've never gotten rid of the first drop when taking a BSL.
At my workplace, which is located in the US, the facility-wide policy is to wipe away the first drop of blood and utilize the second drop of blood as the testing sample.
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Specializes in Surgical, quality,management.
At my workplace, which is located in the US, the facility-wide policy is to wipe away the first drop of blood and utilize the second drop of blood as the testing sample.

I have never heard of this until i came to this site.........trained in Ireland (royal marsden policies book)

and worked in multiple sites in Aus and do not wipe away either. just another reason why posters should not state with absolute certainty that

the way that something is done at thier facility is the only way!!

Also agree with the suggestions with the alcohol. I have never used alcohol pads just washed finger and dried it.

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I do! That's my point.

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Specializes in Emergency, Telemetry, Transplant.
Also agree with the suggestions with the alcohol. I have never used alcohol pads just washed finger and dried it.

I remember reading a blurb in a journal (Nursing 20xx or the like) that the current recommendation from those who recommend such things is that the current best practice is to swab with alcohol and let it dry completely. With completely letting it dry, it is not necessary to wipe away the first drop of blood. Maybe my memory is clouded on the issue, but does this familiar to anyone else?

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Specializes in Correctional, QA, Geriatrics.

If the procedure involves either wiping with an alcohol pad and letting the area completely air dry or cleaning the area with soap and water and allowing it to air dry then there is no need to wipe off the first drop and use the second drop. If the swabbed area is NOT allowed to air dry then the first drop needs to be wiped off with a dry gauze so that the uncontaminated second drop of blood can be tested. In any scenario it is not best practice to use a drop of blood that is exposed to the still wet cleansing solution since that can definitely alter the BG results.

I mentioned the calibration because I find quite frequently that the calibration logs aren't done and checking the machine history can revel if the testing solutions were indeed used on the days noted on the logs. An improperly calibrated glucometer is useless and needs to be replaced.

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I do! That's my point.

Do you mean you do wipe away with an alcohol pad or without? Use a dry piece of gauze.

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