Insulin drips on the floor!

[jackieRN03]

Our post cardiac surgery floor is soon to get patients still on insulin drips from CVICU. We usually have a 5 or 6:1 ratio with 2 or 3 techs for 30 patients. Although we do titrate some drips, the idea of having a patient on hourly fingersticks with drip titration is daunting. We are told the assigned nurse will have only a 4:1 ratio but must take 2 pt's with insulin drips. We have been told that many top cardiac surgery hospitals are doing this and are coping well. Does anyone have experience with insulin drips on the floor and if so, how does the pt cope with 24 fingersticks everyday? Is the a desire to get pt's out of CVICU quicker? I have seen some studies about insulin drips and the decrease in deep sternal wound infections but the studies did not show where these patient were located.

[papersacknurse]

I recently left a telemetry floor and the nurse patient ration on a good day usually was 1-6, there were days when I had 7 and sometimes I might get 8 patients. Our floor never counted insulin drips as 2. If a patient was on a cardiac drip the most patient a nurse could have was five. And thats not counting the accuity level. It was constant stress on that floor. And to me I still consider myself a new nurse just having passed the state board last year. So I have only been a nurse for one year and came out of orientation with 6 patients and have been charge nurse at least 3 times. Last month a patient died in my care. His blood pressure was low but had been low doing his stay. I didn't remember the BP being low and I didn't recheck it. I only had five patients that day but their accuity was high. One of my patients the physcian had wrote orders for comfort measures only and to be put on a Demerol drip and another patient had a trach that needed constant suctioning and was on tube feeding and when I went to check the residuals I pulled back stool colored contents. So did I lose focus on the low blood pressure prehaps so. The patient died not as result of the low blood pressure, when his history was reviewed the physcian discovered he had a mass on his heart. Do I feel bad, yes because maybe he would have not died that day if I had rechecked his blood pressure and got him to the unit so that he could be stablized. I just know that some hospitals are taking risks when there are too many patients for one nurse to handle. Now I am looking for a new area to work in so that I can feel that I can deliver safe care to patients.

[Nightrn16]

The floor I work on, I've taken care of insulin drips before with a 9 patient load. I work night shift (and I don't care what anyone says, no one sleeps at night) and on the telemetry floor I work on, we titrate cardiziem, heparin, nitro, dopamine, dobutamine, insulin drips, argantroban, amniodarone, ect. I gotta say that it's annoying to just finally sit down from doing like 5 things and then realize it's time for your hourly blood glucose test.

So I get up, go do it, on the way back to the desk, 2 other people call out wanting stuff, or I gotta fix someone else's heparin, or someone is having chest pain that I gotta take care of. I get them fixed, sit down, write all of 2 words then realize that it's time to check the blood sugar again.

On the floor I work on, the patient care people can't take the blood glucoses, only the extern II's can, and at night we only have 1 of those working occasionally. Most of the time we don't even get an aide, so even if the girl is working that can do them, she's not on the hallway I work on.

I think since I've been there (almost 2 yrs .. still a fairly new nurse) I've taken care of about 5 or 6 insulin drips, all in this situation. Insulin drips sadly do not count as two people in our classification system.

I'd give anything to just have a 4 or 5 patient load with an insulin drip lol.

[grace90, LPN, LVN]

Two nights ago I floated to the cardiac/telemetry floor and had a patient on an insulin drip. This patient's sugar just kept going higher and the drip kept getting titrated higher according to the protocol until he was at 40 units/hour and his sugar was 318. I called the doc at that point, had him made npo, and got the drip rate decreased to 20 units/hour. I also discovered at that point someone had been bringing him Sprite. :angryfire He was a patient I was covering for an LPN, and had taken over midshift at 7 pm. He was getting hourly fingersticks and I was having to hunt down the PCA each time to make sure it was done and find out what it was. The LPN, rightly so, wasn't having anything to do with the drip. But I had 4 primary patients of my own, 3 of which I barely saw because the 4th one was having some issues of her own. I was almost literally running between those two rooms. Any wonder I was in tears by 9 pm. Oh, and they don't decrease our patient load at all when we have an insulin drip.

[Dieselmota]

We do insulin drips on our tele floor and I believe the plan is to move to the tight controls in the near future, but that's not why I called.

We had a situation about a month or so ago. she found a puddle of insulin on the floor be the bed... The nurse never connected the drip to the patient...

:rotfl: HAHA Telehead! That is a very literal "Insulin drips on the Floor!"

[tinderbox]

On the tele floor that I work on, we have patients on insulin drips ALL the time. OUr max patient load is 4. It can be very time-consuming sometimes but if the blood sugars stay consistent, sometimes it's not that bad cuz then you end up checking every other hour instead of every hour. These patients are definitely taken into consideration when charge nurse is figuring out assignments/acuities/pt load.

[lmnurse]

I agree I have worked on a step down telemetry unit and they have attempted to send us patients on insulin gtts and if you have 6 patient and only 2 techs per 22 patients doing hourly FSBS is not very feasible especially if you recieve a new admit or if someone else on the floor is not doing well with BP or anything else for that matter. I think the patients on insulin gtts should be kept where the nurse to patient ratio is lower. Also I know that in one of the hospitals that I work in they have started the new insulin protocols where they want the BS to be less than 130 and anything above that they recieve insulin where before they did not recieve insulin unless the BS was below 150 and maybe 200.

[floridaRNtoo]

Yikes! Your situation sounds unsafe for the patient. Currently our telemetry step-down unit does not take patients on Insulin drips. Our typical ratio is 1:5 and at least half of the nurses are LPNs. I sure hope Insulin drips on step-down units isn't the trend. If so, nurses have to voice their opinion on staffing rations as a united group!

[muffie, RN]

our day 1 or day 2 pts come up from csu with sliding scale and qid chems. we deline everyone morning of day 2. if day 1 pt -3pts assigned. day 2 pts in a regular 4 pt assignment.