Insulin

suzanne4, RN · Mar 13, 2006

And for the facilities that are not requiring a double check for insulin and heparin, what are your facilities doing with chemo-therapy drugs?

These are all on the "hit" list currently with JCAHO. So this refers to hospital facilities only, not LTC. But keep in mind, that if JCAHO is requiring it, and an issue comes up later on and you need to go to court over it, or to risk management at your facility, who is going to stand up for you?

CoffeeRTC, BSN, RN · Mar 13, 2006

Some nursing homes are JCAHO certified so this can be an issue in those facilities. In my LTC, its just not practical...some times I'm checking up to 10 pts 2 X a shift and covering them in addition to the 15 other pts I'm passing meds to and the other nurse (if you have one) is doing the same.

I always remember clear to cloudy. It is nice to be able to save a pt another stick. Just remember that not all insulins can be combined. Lantus should always be given alone and the other combos (70/30, 75/25) should be too.

Best thing to do about the double checks is to know your facility policy. Even if you don't feel comfy and its not required to have a double check, you can and should always ask another nurse to check it.

As far as the lab work someone was refering to...do you mean a PTT or PT and INR?

FreshRN05 · Mar 13, 2006

I am so gald I found this topic here.....I work in an Emergency room over flow and I do TPC so since we have no LVN to give PO meds including insulin, I too have to give it to patients who requires insulin shot...Anyhoo, my question is most of our patients have a sliding scale for Regular insulin and NPH QAM and QPM......standard time for NPH is 0700 and 1600 then for regular insulin before lunch and (1100) and before dinner (1600).....let's say prior to 0700 (before breakfast) I check the patients BS and the result is 98 do I still need to give her the scheduled NPH eventhough the BS is within normal? I know with the Regular you go by what the sliding scale says.....and what about at dinner time since there is an order for Reg insulin and NPH at the same time (1600) if the BS result is still within normal, do I still have to give the NPH? I am fairly new with insulin eventhough we learned it at school, I still get so confused with this and next to narcotics this what scares me the most.....And what about having another type of insulin in their MAR like the 70/30...what does this mean? When I first encountered it I thought I have to draw 70 units of reg and 30 units of NPH then my CN told me that the pharmacy will supply us with the bottle with 70/30 label in it...Whew! And also how about if the BS is 160 and there is a sliding scale of 1 unit of Regular then the patient has a scheduled NPH of 12 units within 1 hour apart.....do I give them at the same time in one syringe or one at a time? And oh in our facility we only need to double check with another RN when were drawing the insulin but only requires one signature...I live in CA, by the way....

oh, one more thing........is it ok to give diabetic patients some snacks (like milk and graham crackers) after insulin is given if their meal tray has not arrived...say the meal tray is like 30 minutes late after administration of Reg/NPH?

bjs54321 · Mar 13, 2006

I know a bit about insulin...so here is some info some nurses are not aware of.

Clear to cloudy-put the amt of units of air into the cloudy insulin...put the amt of air into the clear insulin and draw it up...then draw up the cloudy insulin. Inject into the abdomen for the fastest absorption.

EXCEPTION....do not mix lantus/glargine with any other insulin...this needs to be a separate inject. AND...it should not be injected into the same area as other insulins.

Inject Lantus into the thigh if possible and all other insulins in the abd. Insulins mix in the surrounding tissues and it is recommended to inject lantus in tissues away from humalog/novolog, etc....The effects of the lantus can be altered if injected in the same syringe or in the same area as other insulins.

AND...PET INSULIN PEEVE!....There is no need to have a pt on more than 2 types of insulin....I swear!

Insulin Pumper since 1994 and mother of an insulin pumper,

Shelly

Momto2Boys · Mar 14, 2006

let's say prior to 0700 (before breakfast) I check the patients BS and the result is 98 do I still need to give her the scheduled NPH eventhough the BS is within normal? QUOTE]
Great question. I was told to hold it because it can cause them to go lower but very interested to hear what others say.

bjs54321 · Mar 14, 2006

I wouldn't hold it. NPH doesn't have an onset for 4-6 hrs. Give if breakfast and digestion will happen in that time frame. If I it was regular or humalog/novolog...hold it until the pt is eating or just about to eat breakfast. When I was on NPH.....I injected at 0600 and it was peaking at 1100.

let's say prior to 0700 (before breakfast) I check the patients BS and the result is 98 do I still need to give her the scheduled NPH eventhough the BS is within normal? QUOTE]
Great question. I was told to hold it because it can cause them to go lower but very interested to hear what others say.

momjacksonlpn · Mar 14, 2006

Here in Oklahoma...most of the hospitals 2 signatures are required...however in the nursing home just eh LPN or RN thats giving the injection needs to sign....Also did want to touch on the mixing r/t new nurse ....do not mix lantus with anything...we had a MD get a little extremly upset because a new nurse mixed lantus with reg..just an fyi

bjs54321 · Mar 14, 2006

Lantus can't be mixed with any other insulin and truthfully....should not be injected into the tissue space of other insulins....I guess it renders it less effective. This is what some nurses don't know.

One place I work requires 2 nurses signatures...hospital where there is more than one nurse....LTC...the other job, no cosign is needed...no one to do it

Here in Oklahoma...most of the hospitals 2 signatures are required...however in the nursing home just eh LPN or RN thats giving the injection needs to sign....Also did want to touch on the mixing r/t new nurse ....do not mix lantus with anything...we had a MD get a little extremly upset because a new nurse mixed lantus with reg..just an fyi

cincin · Mar 16, 2006

we dont need two nurses signing here in idaho either.. never heard of it.. i cant imagine doing that when i have 5 insulins to give every morning the other nurse is just as busy as i am..

marylyric · Mar 16, 2006

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.

To err is human that is the point of having another nurse verify your work. If you have 6 or 8 pts. It is good to have someone else verify. I Do not feel that my license says that I can make a stupid mistake with someone elses life just because I am a RN.

Debbie G · Mar 17, 2006

Two signature for insulin is recommended by ISMP and others, but not mandatory unless your policy says so. Anyone out there using continuous insulin drips on med- surg (not critical care) floors?

melpn · Mar 17, 2006

FreshRN05- Yes, give the NPH. It has a delayed onset and longer effect, so it won't bottom out her sugars now. The NPH is what will keep her sugar in line for the next half of the day; think of it as maintenance insulin. Without it her BS will be high later and you'll be covering her with regular again. Hope this helps.