If you don't know...please ask!

[mcknis]

Just want to throw this out there to everyone, but if you are encountering a new patient diagnosis, skill, treatment, etc. and are uncomfortable with it, please ask for help.

Case in point...was receiving a patient from another nurse (very seasoned with 20+ years of knowledge) at 1900 who was placed on an insulin gtt at 1600. The FSBG on presentation to the ER read HI and the initial blood glucose was 1250, coverage given. The gtt was started at 1600 and second blood glucose was obtained at 1710 reading 850, no coverage given. No bolus given and no change in gtt made. At 1900 go in to check FSBG, and result now is 442. Questioning nurse why no change had been made, and with a blank stare she says, "I don't know. I don't know how to read the order sheet. I checked with ****, LPN, and she said that it seemed ok." I love all of our LPNs, but since when do we check an IV gtt with an LPN? Needless to say, myself and the charge nurse sat down with this seasoned RN regarding how to read the insulin gtt order sheet.

All in all, we are in a profession of caring and preserving the lives of many. If we make a mistake, it can, and does cost people their lives. PLEASE, PLEASE if you do not know how to do something, are uncomfortable with something, speak up and ask! Asking never hurt anyone, but not asking has! No one knows everything, and some know more than others (not me), but we need to get the boldness to stand up and be patient advocates, not guessers!

[NJMike]

All in all, we are in a profession of caring and preserving the lives of many. If we make a mistake, it can, and does cost people their lives. PLEASE, PLEASE if you do not know how to do something, are uncomfortable with something, speak up and ask! Asking never hurt anyone, but not asking has! No one knows everything, and some know more than others (not me), but we need to get the boldness to stand up and be patient advocates, not guessers!

:up:Great post.

[Sun0408, ASN, RN]

Agree 100%..

[deftonez188]

I also believe that encouraging teamwork and friendship among co-workers creates an environment where we can ask those questions we SHOULD know the answers to, but are currently delirious/human and unable to recall.

[leslie :-D]

ok...huge knowledge deficit here.

if the sugar is steadily decreasing, what was wrong?

leslie

[Lucyinthesky]

ok...huge knowledge deficit here.

if the sugar is steadily decreasing, what was wrong?

leslie

You want to bring the BS down slowly and controlled... if it comes down too quickly it can cause cerebral edema. We have an endocrinologist that has us actually hang a D5 gtt with an insulin gtt once the BS gets into a certain parameter to prevent this from happening.

[canoehead, BSN, RN]

It's better to ask a stupid question than to make a stupid mistake.

[Zaphod, BSN, RN]

When the sugar reaches 250 is when you would see a d5. In this instance it was fine as it was decreasing, but the dose was probably pretty high. In some other case the patient might not be so lucky. Pretty dangerous not to be able to read an insulin sheet. Maybe an inservice is in order.

[pedicurn, LPN, RN]

You want to bring the BS down slowly and controlled... if it comes down too quickly it can cause cerebral edema. We have an endocrinologist that has us actually hang a D5 gtt with an insulin gtt once the BS gets into a certain parameter to prevent this from happening.

We do that too .... though don't need an Endocrinologist ...our ED docs sort it LOL

[RNperdiem, RN]

I am a little confused too.

Was there an insulin titration nomogram and perhaps the nurse didn't know about? or was not following correctly?

I do agree with you totally about asking questions.

[pedicurn, LPN, RN]

I am a little confused too.

Was there an insulin titration nomogram and perhaps the nurse didn't know about? or was not following correctly?

I do agree with you totally about asking questions.

Seems the nurse didn't know how to read an insulin titration order .... ?brain fart ?never knew

Anyway ....very very bad situation

[mcknis]

Oh yes I need to clarify. The order was not followed because of not checking the accucheck every hour which would have resulted in titration of the gtt. By the time I looked at the order, per our standard order sheet, the gtt would have been at 14 with 16 units administered. We continue to titrate until the accucheck is within a range of 80-120. As Lucy mentioned bringing it down too quickly cancause edema and we also start d50.45ns if needed to allow a gradual decrease. Sorry for the confusion though.