Insulin adjustment

Nurse0887 · Apr 19, 2014

Sorry you had trouble. Where did you see advice that you can change a drug dosage with out an MD order?

Supercandy131 · Apr 19, 2014

I actually read on several forums that it is practiced differently and at my prior job we adjusted the insulin accordingly due to carb control. I have been reading in my state board of nursing guidelines to see if there's any circumstance that it's acceptable.

ProudMom511 · Apr 19, 2014

I'm a newly graduate RN and I know for sure that giving a dose other than what's ordered by the MD is definitely practicing medicine without a license. You absolutely can hold a med if needed, then inform the MD and document the reasons for holding it and you will not be in any trouble.

psu_213, BSN, RN · Apr 19, 2014

If the MD order is to adjust doses based on carb counting, then yes. If the order is just for SS insulin or routine insulin, then you have to go by that. And try and stay away from getting legal advice from online forums.

ktwlpn, LPN · Apr 20, 2014

You can hold insulin if your patient is refusing to eat-hold it and call the MD immediately for further instructions. You must follow your facility's policy and the patient's orders. You can't just "make it up as you go". If this was not the policy you were wrong.

You can certainly try to plead your case but instead of arguing how you think you were right try focusing on what you learned and what you would do differently in the future and take responsibility for your actions .You may get a different response if you STOP trying to be right at all costs. Good Luck.

systoly · Apr 20, 2014

what are the credentials of the entity that provided the teaching ?

Supercandy131 · Apr 20, 2014

Thank you so much everyone. I don't mean for it to seem like I'm not tryi to take blame. When I spoke to the dr she educated me on not doing that as she said it was practicing medicine. I understood what she was saying and took it seriously. I plan to learn from it. I am just upset because I did in fact get term from my facility because they quoted it as "dispensing meds without a dr order" I have done some research into my states actual rules and regulations and I came across a rule that said withholding a med is allowed as long as it is documented why and that the dr was notified which I did in fact do both. I really liked my job and am just upset that they would do this.

CapeCodMermaid, RN · Apr 21, 2014

Holding insulin or giving a 'partial dose' are two different things. It's nursing judgement to hold insulin if someone's blood sugar is too low or they didn't eat. Then, of course, you would call the MD for new orders. Giving a partial dose is, indeed, practicing without a license. You did something without an MD order. I echo what one of the previous posters wrote....don't be practicing based on some random site on the internet....this one included.

Supercandy131 · Apr 21, 2014

Well I just talked to corporate HR. They said that I have to abide by company policy and state rules. I ended up losing my job this was definitely a learning experience and I will jot make this mistake again.

ktwlpn, LPN · Apr 22, 2014

Know your policy and procedures, that's the bottom line. Just because your BON permits you to do something if it is not in your policy and procedure you can't do it.

LTCNS, LPN · Apr 22, 2014

I'm so sorry you lost your job OP. If nothing else, like you said, at least it was a learning experience for you, and something you can pass on to another nurse you might be in the position of training later down the road. We've all had those learning experiences that have helped us to become better nurses. Hang in there and hold your head up. You will be fine.