Missed fingerstick

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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!

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

The OP is talking a 15 minute time lapse. Im pretty sure it would be okay to treat accordingly. Ya know like when you find that BS of 30 in the middle of the night and give OJ. You don't retake the BS 2 minutes after giving, you wait until the OJ has time to start working, and treat accordingly. in 15 minutes you have a BS of 40, 30 minutes BS of 70, 90 minutes BS of 300+ LOL

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Specializes in Developmental Disabilites,.

On my floor, the pts get a red tray with a big sign on it that says do not eat without having you sugar level checked, the dietary aid also verbally tells that pt not to eat. If a Pt still eats we just chart that the Pt refused.

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Specializes in CVICU.

I don't know if it's a facility difference or if it's because I'm ICU, but if I called a doc to report a missed fingerstick they'd probably scream at me for being idiotic enough to call them. If we miss one, we just do it to check for current status. If the numbers aren't too crazy high or low, just wait for the next one to roll around and recheck and cover then.

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Specializes in Dialysis,M/S,Home Care,LTC, Admin,Rehab.

I'd notify the MD :)

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Specializes in Hospice, Ortho/Neuro Rehab, camp nurse.

hey everyone, it's me again the T1 Diabetic. Definately definately do the fingerstick, especially if the Pt is on a S.S. Call the MD, it's an honest mistake.

These are the ways we learn.

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Specializes in LTC/Skilled Care/Rehab.

I would check their BS and then probably treat it accordingly. I work in LTC and many of the residents eat at odd time. Most of them have diabetes because of bad choices (like drinking soda all day or eating ice cream before dinner). Some of the residents will have BS of over 400 regularly. When I ask them if they have consumed anything between lunch and dinner they will say no but I'm pretty sure they are lying. And these aren't patients with dementia or confusion.

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Specializes in Spinal Cord injuries, Emergency+EMS.
How do know how to treat? Sliding scale is based on a pre-meal blood sugar, not a blood sugar taken after eating.

Emily

a sliding scale is based on the blood sugar that hour regardless of pre-post-during

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a sliding scale is based on the blood sugar that hour regardless of pre-post-during

Well, that actually depends on the patient and the order.

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You should check it anyway, even if they have all ready eaten. If their insulin coverage is the same no matter what their bs is (eg 5 units novolog with meals), then I'd just check the sugar and give the insulin. If it's a sliding scale, you really can't go by that sliding scale if it's a blood sugar you checked after eating. You'd need a doctor's order on how much to give. If their sliding scale started at 150 and their after meal bs was 149 or under, then you'd be safe. Otherwise, you would then need a doctor's order and I would tell them what exactly they ate. The doctor would be a lot less mad about you calling them for this than they would be later on when the bs is 400 and the next nurse tells them they didn't get their insulin or their bs checked at lunchtime, believe me! Don't try to cover up stuff life this... it's better just to admit your mistake and call the doctor yourself and take care of the problem.

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Specializes in Med Surg.

Somewhat off topic but the hospital where my wife is a frequent guest has a policy that the BS isn't done until the tray arrives on the floor. The tray is left at the nurses station until the finger stick is done and any insulin is given. Of course the tray sometimes sits there for an hour before the nurse gets time or remembers to do the FS and then maybe another 20 minutes or so to get back with the insulin. By that time the food is stone cold and the patient refuses to eat it. So the pt. receives insulin but doesn't eat until either another tray is brought up or a family member makes a run to the nearest fast food joint.

As far as the OP goes, go ahead and do the FS, get the value and call the doc for instructions. You are not the first person to have this happen and I doubt you'll be the last.

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Specializes in Hospice, Ortho/Neuro Rehab, camp nurse.
I would check their BS and then probably treat it accordingly. I work in LTC and many of the residents eat at odd time. Most of them have diabetes because of bad choices (like drinking soda all day or eating ice cream before dinner). Some of the residents will have BS of over 400 regularly. When I ask them if they have consumed anything between lunch and dinner they will say no but I'm pretty sure they are lying. And these aren't patients with dementia or confusion.

Hmmmm, Diabetes is not caused by bad choices. When I was 6 and lying in bed in a coma, it was not my choice. Type 2 may be caused by (overweight, no exercise and such) but I still think " caused by bad choices" is not a good choice of wording. Ummm my blood sugar can get to 400-500 without changing a thing I've done or eaten. There are many things that can cause a high blood sugar. I take very good care of myself , been living with Diabetes for 38 yrs. Please be careful in saying your residents are lying to you, do you really know that or is it a guess? Not trying to be nasty here, I just want to give you a perspective from a Diabetic. We as Nurses treat the blod sugar, educate Pt's on diet and what not, but we are not here to judge anyone.

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Hmmmm, Diabetes is not caused by bad choices. When I was 6 and lying in bed in a coma, it was not my choice. Type 2 may be caused by (overweight, no exercise and such) but I still think " caused by bad choices" is not a good choice of wording. Ummm my blood sugar can get to 400-500 without changing a thing I've done or eaten. There are many things that can cause a high blood sugar. I take very good care of myself , been living with Diabetes for 38 yrs. Please be careful in saying your residents are lying to you, do you really know that or is it a guess? Not trying to be nasty here, I just want to give you a perspective from a Diabetic. We as Nurses treat the blod sugar, educate Pt's on diet and what not, but we are not here to judge anyone.

Ha, ha, ha.... You're clueless. My husband is a Type 2 Diabetic. He was diagnosed at the age of 27, the same as his mother. He is 5"8', 140lbs. He eats healthy and he fit none of the "classic profile" for Type II Diabetes except for the family history. Despite his best efforts, he sometimes still have BS in 200's. Educate yourself before you make assumptions about what causes high BS, it most cases it has nothing to do with "bad choices".

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