No more glucose checks by CNAs/PCTs

[Paws2people]

Let me start off by saying I live in NY. My hospital just told everyone that CNA's/PCT's can no longer do fingersticks. They say that it came from the Board of Health rather than the hospital itself. They didn't explain why it is being enforced, so I was wondering if anyone had any insight as to the reasoning. I asked management, but they themselves didn't know. Thanks to anyone who can shed some light.

[alexis_xoxo]

At our facility, the glucometer automatically charts the reading and we were taught to 1. Alcohol pad 2. Dry with gauze 3. Poke 4. Wipe first drop 5. Collect second drop

[SoldierNurse22, BSN, RN]

Oh wait I see your point regarding the automatic upload of the results. Another possibility might be if one doesn't clean the surface of the finger in the first place, the results are skewed!

These are certainly all possibilities, which is why I believe they require so many inservice hours/mandatory CE classes on how to properly take finger stick BGs and other POCs at my hospital. But a nurse could just as well make these mistakes too. I'm still not in favor of only allowing nurses to do these.

My intent wasn't to take a side. My only purpose in commenting was to shed some light on the fact that there are errors beyond charting errors that one could hold a nurse accountable for in practice that are harder to hold UAP accountable for.

I understand both sides of the argument and I respect both. Both make very good and valid points.

In either case, just like BP readings, the responsibility for ensuring that one delegates to trained, safe, competent UAP absolutely falls on the nurse, as well as the consequences should treatment be rendered based on inaccurate data. It's up to the nurse as to whether or not s/he feels comfortable delegating that responsibility to someone else.

[martymoose, BSN, RN]

If we are using technique as an excuse to not have techs do the bg's, by that same assumption should they not do VS, blood work, etc?

Let me tell you, I'd trust my techs with their blood draw techniques over my lack of abilities anyday!!!

[JDZ344]

At our facility, the glucometer automatically charts the reading and we were taught to 1. Alcohol pad 2. Dry with gauze 3. Poke 4. Wipe first drop 5. Collect second drop

We wash the hand, no alcohol pad.

[alexis_xoxo]

Interesting. We're not allowed to use alcohol pads. Something to do with drying out the skin and causing it to harden. Our policy states to use plain water and let it air dry.

Alcohol may dry out the skin but killing bacteria is essential.

[SoldierNurse22, BSN, RN]

Interesting. We're not allowed to use alcohol pads. Something to do with drying out the skin and causing it to harden. Our policy states to use plain water and let it air dry.

.

Alcohol may dry out the skin but killing bacteria is essential.

I've seen an argument made for soap and water to kill bacteria versus alcohol for the exact reason indicated in KatieP86's post.

[Nurseworks, ASN, RN]

Where I work (also in NYC), CNAs cannot perform finger-sticks but the PCTs and MAs can. Haven't heard anything about any changes to this policy.

As for alcohol pads, the switch to chlorhexidine for new IVs is already occurring, not sure if it will apply to finger sticks though.

[alexis_xoxo]

.

I've seen an argument made for soap and water to kill bacteria versus alcohol for the exact reason indicated in KatieP86's post.

She said plain water, not soap and water.

[SoldierNurse22, BSN, RN]

She said plain water, not soap and water.

Right...I saw that. The method I read about was close, though it called for soap.

https://nfb.org/finger-sticking

Article discussing the use of soap and water.

http://www.diabetesselfmanagement.com/Blog/Diane-Fennell/an-important-step-for-accurate-glucose-readings/

Interesting article here compares fingersticks before and after peeling fruit, one of the groups cleansing the sites with tap water and the other with alcohol. Folks who used alcohol had elevated readings while the folks who used tap water had consistent readings before and after.

http://www.diabeticconnect.com/diabetes-discussions/general/15748-skip-the-alcohol-swab

Another article regarding soap and water.

https://www.bd.com/us/diabetes/blood-glucose-monitoring/how-to-test/

Another article regarding soap and water.

An important thing to keep in mind is that if you have a patient whose skin is becoming hardened from constant use of alcohol pads, you have the potential for the integrity of the skin to become compromised, putting them at higher risk of infection. Diabetes tend to heal slower anyway, so a method in which you achieve cleansing without the harsh, negative effects of the alcohol swab ought to be duly considered.

[sistrmoon, BSN, RN]

I also practice in NY and our PCA's are still very much allowed to check FSBG. It could be your facility's policy.

Same here.

[IrishErin]

I very much envy all of you that have aides! We have always done all of our own care for our patients.

[CardiacKittyRN]

Where I work the RN has to check blood glucose... there is a place in our charting also where we have to name another RN who verified our insulin dose... someone mentioned using BP's from UAP's.. I recheck those also, but I do work on a cardiac floor...