Is this considered a med error? New nurse

[Triishha]

Hello everyone, 

I’m a new nurse and got a job at a specialty hospital.  I have a patient who goes to dialysis around 10 am and have an accu BG check and insulin order due at 12 but he’s away from the unit!  When he gets back around 230, I performed his accu check and administered his insulin per the order while he received his lunch that he missed when he was gone.  Then, at 5 pm I performed his accu check before dinner and administered insulin again!  Would that be too much? I’m just confused when it comes to patients being off the unit.  Should I have just held the 12 pm accu and insulin and checked it at 5pm? This morning when I came in.. I checked his BG and it was low. I gave OJ and sugar but I can’t help but think it’s my fault from the night before.  I feel like I’m messing up and when I ask staff sometimes I get different responses which leaves me confused.  

Thank you for the help

 ? 

[IvyNurse1908]

If I had been the nurse in this situation I would have held the 12:00 dose. It was well over two hours late. Insulin is very time sensitive. When in doubt you could have asked for a second opinion from another nurse or called the MD. With that being said I wouldn’t consider this a med error but I would do an event if you feel like patient harm was done.

It’s good that you’re concerned as I’m sure you’ll learn a lot from this but please don’t be too hard on yourself. No nurse is perfect. Being a new nurse is hard. It sounds like you’ll make a great nurse.  

[amoLucia]

When a pt leaves your facility for another responsible facility, s/he becomes THEIR responsibility. The noon BCG & insulin management would then become their task.

You're a newbie - you'll catch on. I wouldn't worry re an error.

The one thing I did worry about was if critical meds were omitted like if pt was out of bldg, say for a Doc apt or prolonged test. I would make DANG sure a vulnerable CHF pt got daily lasix 40, even if late. Sometimes I would resched it as a one-time 'give upon return' dose. NEVER EVER was I ever challenged.

[kbrn2002, ADN, RN]

Since the absence during a scheduled med time is a regular and predictable thing due to the patients dialysis schedule you should get directions/orders from the PCP on what they believe the best course of action for this patient is.  I agree giving the lunch insulin over 2 hours later than the regular scheduled time then turning around and giving them supper time scheduled insulin just a couple of hours later is not a good solution for most diabetic patients. 

I work dialysis and pre-COVID patients would often bring a meal and their diabetes supplies with them if they were scheduled to dialyze during that meal time, any ordered meal time meds including glucose checks and insulin would be given by the dialysis nurse. 

However during COVID our rules changed and eating during treatment is no longer allowed so any meds including insulin that are to be given with food would not be administered. 

Interesting conundrum as I worked LTC prior to dialysis, this was before COVID and we always sent out our dialysis residents with their diabetic supplies including insulin. Now that I work the other side I see none of the LTC residents arriving with any supplies. We stock a glucose meter and glucose gel in the case of a patient becoming hypoglycemic but we do not have any insulins so our only option for a pt with a dangerously high blood sugar would be to stop treatment and send them back to their facility. I haven't run into that yet but the possibility of it happening certainly exists.