Missed fingerstick

Nurses General Nursing

Published

Specializes in Psych.

I am a new grad nurse and just started working on an acute psychiatric inpatient unit 3 months ago. The patients are not bed bound and are up and about on the unit. I had a patient who has fingersticks TID before meals and is on sliding scale. I was finishing up an admission and realized it was already 11:45 and lunch gets served at 11:30. I went to find my patient but she was already done eating her lunch.

I asked another nurse what I should do regarding her 11:30 fingerstick and the nurse told me to skip that one since the patient knows she's supposed to get fingerstick before lunch and she didn't wait or ask for it. But as the day went on, I am rethinking what I should have done. I just want someone else's opinion and rationale behind what should have been done. I will probably find out if there is some official policy regarding missed FS the next time I'm back at work. TIA!

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Specializes in home health, dialysis, others.

Sorry - it requires an incident report. What if the BS was 285 and required coverage? At the very least a call to the MD to cover yourself would have been appropriate. And of course you needed to document why the ordered procedure wasn't done.

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For me, it would depend on what her numbers had been running. If she hadn't required coverage at lunch for a while, then I'd just monitor for signs of hyperglycemia and not really worry about it. If she was normally requiring insulin with lunch, I'd get it asap, call the doc, and ask how much they want to cover with.

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I'm a new grad also, but I have not started my job yet. I'm a bit scared of making mistakes too. However, at least the mistake you made did not harm your patient. For example, if you gave your patient insulin when he/she has low blood sugar, it could kill them! But missing an insulin dose will only raise their blood sugar, and should not cause them severe harm in the long term. Just make sure it's documented! I had to take my diabetic cat to the vet this evening as he was very ill, and the vet told me his blood glucose was 27! I feel bad because of that as he was acting strange for several days and I should not have given him insulin before checking his sugar. Hypoglycemia is a lot more severe than hyperglycemia.

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Specializes in Geriatrics.

When ever I missed finger sticks, I would take it as soon as I realized it was missed & call the Doc, letting him (or her) know that it was taken after they ate & why. If they want coverage they will tell me how much to give. Then I document it all in the patients chart. I also remind the patient that they are also responsible for thier care & should look for me if it's time for thier stick and I'm not there to do it.

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Specializes in Medical.
... if you gave your patient insulin when he/she has low blood sugar, it could kill them! But missing an insulin dose will only raise their blood sugar, and should not cause them severe harm in the long term... I should not have given him insulin before checking his sugar. Hypoglycemia is a lot more severe than hyperglycemia.

It's true that giving insulin to a patient with a low BSL is dangerous, which is why you should never give insulin unless you have a glucose level that's less than 15 minutes old. But skipping even one dose of insulin, in an already sick patient, can be enough to tip a type 1 into DKA.

That said, an inpatient stable enough to be in psych is probably going to be okay. Our patients quite often eat despite knowing they need to have a preprandial check - in which case we document that the level was taken after or while eating. You still need to check it, though.

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Specializes in Acute Care, Rehab, Palliative.

When this happens where I work we just take the BS when we discover the miss and treat accordingly. We don't usually have to notify the doctor or do any sort of incident report, usually just a note.

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I would have done the finger stick at 11:45.. and treated accordingly

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Sorry - it requires an incident report. What if the BS was 285 and required coverage? At the very least a call to the MD to cover yourself would have been appropriate. And of course you needed to document why the ordered procedure wasn't done.

Yes -- Any place I've ever worked, it would need to be treated as a med error (incident report and notify the physician).

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When this happens where I work we just take the BS when we discover the miss and treat accordingly. We don't usually have to notify the doctor or do any sort of incident report, usually just a note.

How do know how to treat? Sliding scale is based on a pre-meal blood sugar, not a blood sugar taken after eating.

Emily

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Specializes in SICU, MICU, Med/Surg, ER, Private Duty.

i would take it as soon as I realize I missed it, even though they are eating, or have eaten. and then depending on the results notify the MD. The MD will probaby tell you to leave it alone, or order an insulin stat dosage.

Then document. That way you can cover ur a**

a missed fingerstick is an incident report. What are you going to say, when you get sited, "the nurse told me to don't worry about it"

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Specializes in SICU, MICU, Med/Surg, ER, Private Duty.
How do know how to treat? Sliding scale is based on a pre-meal blood sugar, not a blood sugar taken after eating.

Emily

well sometimes patient eat meals, at odd times. Sometimes they or the family don't even tell you that they are going to eat a meal... so then what are you going to do.

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