Insulin drips patients on L&D

labordude, BSN, RN · Feb 16, 2019

I do insulin drips on my labor patients more frequently than I expected. They are 1:1 patients. We have a robust order set for this situation.

jodyangel, RN · Mar 11, 2019

On 1/29/2019 at 8:37 AM, Upgrading_Status said:
Does this occur in your facility?
Is this common or are they transferred to ICU?
What is your facilities policy regarding pregnant patients needing insulin drips?

We do them on our Mother Baby Ante floor. Its with a program which tells you how to go up or down on the drip. You will have 4 other patients.

**canoehead, BSN, RN** · Mar 12, 2019

On ‎2‎/‎3‎/‎2019 at 10:18 PM, ashleyisawesome said:
My unit's protocol is that anyone (with diabetes) in active labor who has 2 blood sugars in a row that are over 100 gets put on an insulin gtt, and yes we titrate them on our unit. The patient is automatically 1:1 and gets hourly blood sugars until they are off the gtt. The gtt is usually d/c'd once they deliver unless they are type 1 DM, then endocrinology is consulted and they decide what to do with it, but they remain on our postpartum unit unless they are in DKA or something and need to move to stepdown or ICU.
I also did insulin gtts when I worked on med/surg, often with a 6 patient assignment.

What do you think about that? With the stress of labor I wouldn't be surprised if nondiabetics were normally over 100, and diabetics could likely run higher. An extra drip adds to the confusion, my very uneducated opinion would be to not think about a drip until they are at least over 200.

The many reasons labor becomes an illness is alarming to me.

preciouspkgs, ASN, BSN, RN · Apr 15, 2019

I don't have anything to add on the insulin drips, but I want to know where you all work that laboring patients are 1:1 for any reason; we routinely have 4 to 5 of our own patients on L&D's down here (and I worked L&D in a high risk perinatal center, and am now in another high risk perinatal center), its why I moved to postpartum a few months ago - I was constantly in fear for my license I miss it, but I haven't found anywhere here that follows safe guidelines.

AZBlueBell · Apr 15, 2019

3 hours ago, preciouspkgs said:
I don't have anything to add on the insulin drips, but I want to know where you all work that laboring patients are 1:1 for any reason; we routinely have 4 to 5 of our own patients on L&D's down here (and I worked L&D in a high risk perinatal center, and am now in another high risk perinatal center), its why I moved to postpartum a few months ago - I was constantly in fear for my license I miss it, but I haven't found anywhere here that follows safe guidelines.

What?! I have never even heard of this! More than 2 active labor patients?? I feel as though my facility is not as strict as others in terms of “high risk” being 1:1 but I have never had more than 2 labor patients at one time, ever.

klone, MSN, RN · Apr 15, 2019

6 hours ago, preciouspkgs said:
I don't have anything to add on the insulin drips, but I want to know where you all work that laboring patients are 1:1 for any reason; we routinely have 4 to 5 of our own patients on L&D's down here (and I worked L&D in a high risk perinatal center, and am now in another high risk perinatal center), its why I moved to postpartum a few months ago - I was constantly in fear for my license I miss it, but I haven't found anywhere here that follows safe guidelines.

I’m the manager, and I insist on following AWHONN’s staffing guidelines. I’m sorry your facility staffs so unsafely. You’re saying you have 4 patients in LABOR? Not antepartum?

preciouspkgs, ASN, BSN, RN · Apr 17, 2019

On 4/15/2019 at 4:22 AM, klone said:
I’m the manager, and I insist on following AWHONN’s staffing guidelines. I’m sorry your facility staffs so unsafely. You’re saying you have 4 patients in LABOR? Not antepartum?

Yes. At the hospital I last worked labor and delivery at it was not uncommon to have 4 to 5 patients in labor at one time; with multiple being on pit and maybe 1 on mag. Staffing is horrendous here. I'm now on mom/baby elsewhere but talking to and seeing the nurses here in l&d it's the same thing.

preciouspkgs, ASN, BSN, RN · Apr 17, 2019

On 4/15/2019 at 1:24 AM, AZBlueBell said:
What?! I have never even heard of this! More than 2 active labor patients?? I feel as though my facility is not as strict as others in terms of “high risk” being 1:1 but I have never had more than 2 labor patients at one time, ever.

I wish. Happens frequently here in Florida at alot of facilities based on the nurses I have spoken with and the facilities I've worked at. It's why I left l&d, at least until I move out of state

klone, MSN, RN · Apr 17, 2019

That's crazy. I've worked in 7 different L&D units in 4 different states, and I've never heard of L&D nurses taking more than 2 labor patients at a time, except in the rare instances of multiple people walking in at the same time in active labor, and basically the nurses just doing what needed to be done until help could arrive (and I can count on 1 hand the number of times that's happened in my career).

SoldierNurse22, BSN, RN · May 1, 2019

Our unit takes patients on insulin drips, too, and they're not often 1:1 patients. We have extremely poor staffing ratios, often times meaning that we aren't 1:1 with our labor patients, either. It's a hot mess. I can't tell you how many times I take triage patients while I have a laboring mama. I don't think an antepartum patient on insulin is too dangerous on an L&D floor, but I do think it is critical to ensure proper staffing levels before taking these patients.

littlerayofsunshine, BSN, MSN · May 4, 2019

Our patients were kept on high risk area of birth center when on insulin gtt. We did monitor closely and would have 1:1 care when laboring. Our nurses were trained to titrate per our protocol.

tekialove · Jun 17, 2019

So, how Is any LD nurse having 4-5 patients in Labor, No way and if they are on PIT or MAG, not feasible! So no 15 minute charting there, I guess.