Med aides giving insulin

Nurses General Nursing

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So, I have heard that a few states might start considering allowing medication aides to check blood sugar and then administer sliding scale insulin. The idea is that some facilities already allow the aides to check BGL and then report the results to the nurse. The nurses then administer the insulin based on what the medication aide told them. I am sure you all know how confusing it can get with so many accu checks. I was wondering if anyone else had heard anything about this, if any states actually implement this, and what everyone thinks about it.

I myself am a do it yourself-er. I want to do my own accu checks and administer my own insulin.

Specializes in Cardiac/Progressive Care.

At my facility, insulin is considered a high risk medication. After being drawn up, the amount has to be double checked by 2 RNs and documented as such by both before it can be given.

The meters we use scan the patients MRN on their ID band, and the reading is transmitted wirelessly to the lab result page in the electronic chart.

So, I have heard that a few states might start considering allowing medication aides to check blood sugar and then administer sliding scale insulin... I was wondering if anyone else had heard anything about this, if any states actually implement this, and what everyone thinks about it.

Insulin is a High-Alert drug; many facilities require two RNs to check before administration. The top five high alert meds identified by the ISMP (Institution for Safe Medication Practices) are:

1. Insulin

2. Opiates and Narcotics

3. Injectable Potassium Chloride or Phosphate

4. IV Anticoagulants

5. NaCl solutions above 3%

(International Journal for Quality in Health Care 2001; Vol 13 No. 4)

I would invite anyone to take a look at that list and decide if you want unlicensed assistive personnel to administer them.

Given the general availability of this type of information and JCHAO scrutiny, why a facility would risk the exposure by doing this is beyond me.

Specializes in Hospital Education Coordinator.

My interpretation of the nurse practice act for my state is that the licensed nurse has the responsbility of using nursing judgement. This cannot be delegated to a non-licensed person. Determining whether or not the glucose reading requires an intervention can be construed as nursing judgement. In my opinion, this responsibility lies with the RN/LVN.

Specializes in ICU.

I've always been responsible for checking my patients blood glucose levels, even before I was a CNA (I was a non-certified Nurse Aide for a while on a med/surg floor). It's not hard. There's no reason a tech can't do it.

In my state, Med Aides in LTC can administer insulin. They just have to take an additional test on insulin with their Med Aide exam. Some do, some don't.

Specializes in Critical Care.

In my facility everything is pretty cut and dry. The hospital recently initiated a "pilot" ICU drip which means that all patients who do not pass confirmatory screening must be put on an insulin drip. We use an online calculator to figure the dosage changes, but basically, their target range is between 101-150. For the first 24 hours, we check their BGL q2. The nurse changes the drip dosage accordingly based on the calculator for the pilot gtt. If the patient maintains the target range for 24 hours, we then check their BGL q4. I do not see what is so hard about doing CBGs, as long as you do it according to proper procedure.

Specializes in Hospital Education Coordinator.

My rationale for interventions being with the licensed nurse's domain is that sometimes there are extenuating circumstances or a change in condition that requires nursing judgement. Blindly following a medication administration order has gotten many people in trouble. However, I concede that longterm care and acute care differ because one does not expect a change in condition as quickly in LTC.

I'm sorry, but I will never understand nurses that don't want CNA's to do blood sugars. They are trained to do so and it is NOT rocket science. It's not like it's a result open to interpretation, either...you don't put it on a strip and try to interpret the color to get your result (like a UA strip, or something). Add drop of blood, read number.

I have way too much to do already than to add getting all the blood sugars to it. I trust that our CNA's can perform the task. Simple.

Nice. Be doubly sure as well that your CNA is one who pays utmost attention and does not have the readings mixed up.

Nice. Be doubly sure as well that your CNA is one who pays utmost attention and does not have the readings mixed up.

You can always double check the test yourself just by going back on the machine. Some places allow aids to change foleys, start iv's, ect. I wouldn't mind the bs check, I would mind the insulin. What about assisting the pts with the insulin? They could do that in assisted living. Help the pt who doesn't see very well to draw it up. If the state allows med aids then insulin is a med. People at home do not consider it a " high risk drug"

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