Insulin

[Momto2Boys]

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!

[suzanne4, RN]

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.

[calmone]

In my facility (LTC) we have to check the insulin syringe with another nurse but only the one giving it has to sign. The second nurse just has to verify the amount and type of insulin drawn up.

[suzanne4, RN]

In a hospital facility, that is under approval by JCAHO, insulin is at the top of the list of what they call high-alert medications and requires the signature of two nurses on the med sheet, or placed in the computer if you use Accuscan or something similar. JCAHO is also spending time when they are at the facility doing their review looking for the two signatures. It has become a big thing.

And this is federal, not state. And even when I attended school, we always had someone verify the insulin dose, and that was many, many years ago. Adn it is normally taught in nursing school, and you may even see a question about it on the NCLEX exam.

[Momto2Boys]

Ok another question regarding heparin. We got a new resident that req. heparin but I remember in nursing school they said that was a red flag drug and labs should be checked and I looked in his chart and there were no lab draws done. Can someone let me know how that works? Should daily labs be drawn? I did not feel safe giving the med so I did not and I let my preceptor know (I am still in training).

Suzanne, are you an instructor? You are or would be a great one;)

[GooeyRN, ADN, BSN, CNA, LPN, RN]

Doesnt get done here in NY...

Not done in PA.

[flasandy42]

>__________________

Here in Florida we need two nurses to check it but no signature is required from the second nurse.

[hafsa44]

The hospital where I work don't require a signature for insulin and for heparin a signature is only required if it's a drip to verify if the dosage is correct and you only need to signatures for the first set up there after you don't need two signatures unless you change the dose again.

[grannynurse FNP student]

>__________________

Here in Florida we need two nurses to check it but no signature is required from the second nurse.

To check what? The dose when drawn up? The administration? I live in Florida and receive insulin when I am hospitalized. I know there are never two nurses when it is administered. As a matter of fact, I've found that current, up to date education concerning diabetes is sorely needed, in my part of the woods.

Grannynurse:balloons:

[athomas91]

if you are drawing 2 different insulins up in the same syringe - remember "RN" - regular before nph.... if a little regular gets in the nph bottle - no real harm... but there is a more significant harm if nph finds its way into a regular bottle...

[Momto2Boys]

if you are drawing 2 different insulins up in the same syringe - remember "RN" - regular before nph.... if a little regular gets in the nph bottle - no real harm... but there is a more significant harm if nph finds its way into a regular bottle...

Great way to remember that. I learned now since I have done it for a few days but that is a wonderful way to learn it.

In nursing school they did teach us to always have 2 nurses present to draw up the insulin but not to admin. I went to school in Colorado but in TX they do not follow that process.

[BKRN]

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.

I was taught this in Nursing school and it was reinterated at the hospital I work at. You have another nurse verify the dosage of insulin not the actual administration. As for Herparin drips and PCA pump setup-2 nurse verification is also required.

[suzanne4, RN]

To check what? The dose when drawn up? The administration? I live in Florida and receive insulin when I am hospitalized. I know there are never two nurses when it is administered. As a matter of fact, I've found that current, up to date education concerning diabetes is sorely needed, in my part of the woods.

Grannynurse:balloons:

The verification is when the dose is drawn up, it doesn't take two to administer it.