insulin coverage

Pepperlady · Jan 17, 2009

Where I work I check my am blood sugar at 0730 and give the insulin based on that. I wouldn't necessarily question someone else doing the blood sugar, as long as it was in a reasonable time frame. I wouldn't want a BGM done at 6 for me to treat with insulin at 0730

dollphyn · Jan 17, 2009

I guess it really depends on when it was taken. On my floor, the night shift tech will take the blood sugars from 0630-0700 before going off shift. We night shift nurses, do not cover with our sliding scale at that time, but tell the day shift nurses the fingerstick or they see it on our white board. Our trays do not come until 7:30-8:00, so it is easier to have it ready for when day shift does their assessments, to already have the sugars and can cover them at that time. This works for the AC and HS patients with our sliding scale.

Now if your patient is every 6 hours or every 4 hours, it really depends when the fingerstick was taken. I had a patient that their fingerstick was at 0400, so depending on what it was, I gave insulin per our sliding scale orders. I didn't hold off and give it to the day shift to do. I did tell the day shift, this what it was and this is how much I gave.

If the fingerstick was taken at midnight, you would think that if your sliding scale or any orders regarding insulins, the night shift nurse, would cover especially if the sugar is over 200 or depending on the case. At my hospital, we cover for over 120 on diabetics.

My advice, would be to find out what the policy is on your floor or what it is at the place you work for. Managers and supervisors are there for a reason and hopefully can help you with the policy.

CathyLew · Jan 17, 2009

yea, it depends on the order. If they have a sliding scale Q4 or Q6 hrs... then you cover after you get the result. Unless the fingerstick is out of our paramiters, and needs a Lab draw to verify the result. Then you have to wait for the Lab draw, and cover based on that.

If they arn't on coverage, and the BS is out of wack, you page the Dr. Many times on the night shift, the Dr would get the result of the Am accucheck being >300 and they would say they would come in and review chart/write orders. So no coverage until maybe 9am when they get there.

It seems they should be covered immediately, but as one Dr put it, the patient's blood sugar has probably been over 300 since midnight. And with some of these non-compliant diabetics, they probably always have a BS of 200-300.

As with lots of things, if you don't like how things are being done. Don't just take the old excuse from the staff....thats how we have always done it. Get with your Nurse managers and discuss if a policy change may be in order. If you get your facts together, benifits, how other hospitals do it, etc... and come to them and be proactive, they would probably appreciate the staff input.

KyPinkRN · Jan 17, 2009

while not optimal control a blood sugar over 200 is not necessarily an emergency situation. i agree with other posters who said that coverage would depend on the order. if a patient is npo, on tpn or something insulin is scheduled for the time that bg is measured. our achs bg people have their insulin scheduled for mealtimes... we usually take their bg about a half hour before that, and its scheduled that way on our mar's

meandragonbrett · Jan 17, 2009

my concern is, how do i know if their insulin is what they said was, i mean what if they told me their insulin was 250 when they actually took it their blood sugar was only 80?

look up the accucheck on the machine or in the computer if you don't trust what you were told. :twocents:

blondy2061h, MSN, RN · Jan 17, 2009

We base AM coverage on what their AM lab draw glucose was and do not do another fingerstick (actually, all of our glucoses except insulin gtts pts are sent to the lab, but that's irrelevant). In this case, it's very easy to know if the true blood sugar is being given.