Insulin Double Check

[owensmommy]

Does your place of work require a cosignature with insulin administration? My hospital has had this as a policy, but recently started reinforcing it. I know that it has a potential for error upon administration, but doesn't just about everything? I agree with the cosign for insulin drip adjustments and PCA/epidurals, cardiac drips, etc. But, SQ insulin? I give almost every patient sliding scale insulin 3 times/shift. So now, I get to hunt down another busy nurse every time?? That's potentially 15+ cosigns per shift! And they have to be documented in the computer at the time of administration. It just seems overboard to me. Oh, and keep in mind, I don't need a cosign while giving IVP narcotics, IV digoxin, and a handful of other potent meds... I tried finding it on the web, and I don't believe it's a state law, just a hospital policy.

[suzanne4, RN]

Sorry, but it should have two signatures on it. The same way that it is supposed to have a second nurse verifying what is in the syringe to begin with. And what most do not understand that even with having a second nurse look at it, there is no proof that you had that done if there is no witness to it.

Any place that I have worked in too many years to count has always required two signatures and it has never been an issue for me to get done.

It is actually per JCAHO that this is being done and has been done for years, since it has been proven that there have been many errors in the past with it, especially even more important now that there are so many different types of insulin available. And if your facility is finally enforcing this, then great. Same as with the other medications that are considered high alert.

It is not something that you really have a choice in if your hospital mandates it, and other nurses will be giving insulin the same time as you, so you can check and verify each other's doses.

Just not a big deal if it keeps someone safe.

What had you been doing up to know with verification? Did you have another nurse verify your dose and correct vial? And if so, and they were not documenting it, where was your proof that you did it?

[cardiacRN2006, ADN, RN]

Yep we double check. And it's been that way for years. It's an easy thing to do to protect pts...

[Becster]

I share owensmommy's frustration. We recently went to computerized documentation. I am on a renal unit where we give tons of insulin. We used to be able to have someone document on paper at the time of checking insulin - easy. Now we have to show someone and either drag them into the room or have them remember who they checked and go back and cosign after admin. Most are busy and forget. Our cosigning rate looks outrageously low now.

I once had a nurse educator tell me an interesting story. I don't know if it's true, but I like it. When he was a new nurse he was caring for an elderly retired RN. He told her he needed to get another nurse to check his insulin before admin and her response was, "are you guys still double checking that? Insulin was the first med that the doctors actually allowed us to administer because they did not was to have to come back to the hospital at night. Interesting that you are still double checking a medication that you can reverse with a candy bar."

Seems silly when put that way. Apparently JCAHO trusts my ablility to correctly administer IV beta blockers and dilantin but I can't dial in 2 units of regular insulin on a pen without someone holding my hand. Interestingly enough, the LPN at the nursing home that I was at did not need someone to double check her for insulin per policy.

By the way, I've seen several insulin mistakes. Each were double checked. The worst was with an insulin drip where the ER nurse set the pump at 60 ml/hr rather than the ordered 7 ml/hr for 7 units per hour. Another nurse checked her work. Obviously, the double-check has become so routine that it really is not working like it should.

[Altra, BSN, RN]

Apparently JCAHO trusts my ablility to correctly administer IV beta blockers and dilantin but I can't dial in 2 units of regular insulin on a pen without someone holding my hand.

So true. Just about every hour that I work I give meds with just as much or more potential for harm as insulin ... and quite frankly I give them more frequently than I give insulin. But no one is double-checking those.

[Babs0512]

I absolutely share your frustration. While we also require double signatures, you try getting a second signature at 0200 when your the only nurse in the recovery room with your patient.

I have not problem with the two signature rule, but I've had to start PCA's in the middle of the night or pain control on post op's without a second signature. I will triple check myself - and sign off the PCA when the patient gets to the floor. Not the best practice, but can't leave a patient in pain either.

[loriangel14, RN]

We have no such requirement where I work thank heavens. It is enough of a hassle trying to get a busy coworker to cosign a waste.:)