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Discussion

Insulin

I need verification on insulin.

If a resident has an order of 18 units of NPH at 4:30 and a sliding scale at 4:30 for regular (lets just say they needed 6 units) do you pull them up in the same needle or seperate needles?

I am a new nurse and I was taught one thing in nursing school and saw it done different in the LTC so I just wanted to double check how other nurses do this.

Thanks!

Featured Replies

  • Experts

You draw them up in the same syringe so that the patient gets only one injection. Insulin syringes normally have a non-removable needle, it does not come off to change.

You always draw up the regular insulin first, then the NPH.

  • Author

Suzanne,

Thank you so much! That is what I was taught in nursing school but not what was done at work. I guess I just needed to hear it from someone else the right way.

Do you know what will happen if anything if they gave NPH & regular in seperate injections at the same time??

Sorry I am a new nurse and I have so many questions. Being a student nurse and working nurse is so different.:uhoh21:

  • Experts

No problems at all, but it just saves the patient a stick. The facility may do it that way, just to make it easier for another nurse to check it. Remember that insulin requires the signature of two licensed personnel before giving it, that they have verified the correct dosage, etc.

  • Author

Thank you again very much for your response!!

You have to have two nurses sign for insulin before you give. Is this just in Texas or other places too??

You have to have two nurses sign for insulin before you give. Is this just in Texas or other places too??

Doesnt get done here in NY...

  • Experts

I am an LVN at a nursing home in Texas, and I administer insulin injections without signatures from two nurses to verify it. There's no need for another nurse to come and verify my work. After all, what's the point of my license?

I also administer Darvocet, Vicodin, Oramorph, Narco, Morphine, and other controlled substances that remain in a locked drawer in my medication cart. No other nurse is required to verify whenever I administer narcotics.

  • Experts

Insulin and heparin injections need two signatures, and this is per JCAHO. And this is if given by an RN or an LPN. This is because of mistakes made in the past and documented all over.

It doesn't matter what you are licensed to give or not give, it is trying to keep you from going to court in the future.

Nursing homes are a different thing, but hospitals require it.

Insulin and heparin injections need two signatures, and this is per JCAHO. And this is if given by an RN or an LPN. This is because of mistakes made in the past and documented all over.

It doesn't matter what you are licensed to give or not give, it is trying to keep you from going to court in the future.

Nursing homes are a different thing, but hospitals require it.

Suzanne, is this a state thing? The hospital I work at doesn't require 2 signatures. Probably is a good idea though.

  • Experts

Definitely not a state thing, but actually federal. Each of the three states that I am licensed in currently has required this the past few years. It is a JCAHO compliance requirement.

Nursing homes are not covered under JCAHO.

Definitely not a state thing, but actually federal. Each of the three states that I am licensed in currently has required this the past few years. It is a JCAHO compliance requirement.

Nursing homes are not covered under JCAHO.

If it's a federal thing, then why are there so many nurses here, including myself, who have never been trained in school or on the job to have another RN witness? I have never needed a second nurse to witness me giving insuling or heparin, both of which I probably give approx 6 - 10 times a day. Same with narcs. In my facility, a witness is only needed to waste a narcotic or setup a PCA. And maybe to verify proper setup of a heparin drip.

  • Experts

Not sure what to tell you, but heparin drips, PCA machine set-ups, insulin and heparin injections are things that require two signatures in hospitals. Narcotics only needs a second signature for a wate , not for administering. They may not be "the law" where you are now, but to comply with JCAHO requirements, your facility is going to need to be able to submit what they are doing in these areas to JCAHO for their next certification.

Peds facilities may require a second set of eyes for any medication given.

Best bet is to check with risk management at your facility.

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