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No More Fingersticks for Techs!!

Posted

Specializes in Community Health, Med-Surg, Home Health.

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i like how u put that wooh. i work n a outpatient dialysis clinic and although we don't do fingersticks we draw blood from their arterial port and let the nurses know anything abnormal. rarely do the nurses do a blood sugar.

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

Our techs do the fingersticks here in Metro Atlanta.

Our accucheck machines then report it to the computer, and our techs write it on the BG flow sheet.

I understand the concern over miscommunicated BG's, however then the same can be said for a misscommunicated BP, like I had tonight, and other vital signs.

My patient was written down at 114/61. When I went in with 80mg of Micardis for him he informed me that the first BP she had taken was 91/56! So I called and got parameters and held the med.

Same thing with a person reporting a BP of 180/78, for example, because they didn't have the person relax their arm on the bed, or because they used the wrong cuff, or because they startled the person at 0400 by flipping on all the lights instead of approaching with respect, and I go in and cover with Hydralazine, when thier natural BP may have been below the set parameter.

If no one is expected to have responsibility and accountability for thier job, all tasks will eventually fall to the first person with a liscence...the nurse.

I personally favor the idea of eliminating techs/cna's/pca's and employing more RN/LPN's to improve continutity of care, but until then we need to raise the bar on our expectations and make sure ancillary staff realizes the importance of the role they play in patient care.

Tait

I use to think that this was okay until last Friday.I was working with another nurse and a QMA which for those that dont know is a cna who has undergone training on passing medications and has passed examination by the BON to be able to do so. I usually pass meds from 2 med carts and it is known to be the heavier med pass with numerous blood sugars, blood pressures, breathing treatments and a couple of gtubes,and temps that have to be done.I was responsible for her and they are suppose to notify the nurse of the blood sugars.Well I work in LTC and is reponsible for about 25 and about 8 blood sugars that get coverage,and are done before meals.She did 2 blood sugar checks. She told me of one but she left to help in the dining room I stayed on the floor to finish passing meds. I work evenings and dinner is served at about 545.She comes back at almost 630 and says oh by the way sos and so blood sugar was over 400 about 439 to be exact. My mouth about hit the floor.I know i should have been on top of that but i got extremely busy and i know thats no excuse but anyone who works LTC can attest.So I had to call the doctor and explain and she was thinking that the lady was having a hyperglycemic reaction which thank god she wasn't because of when i had called. So Ive learned my lesson and its fine to let them do that but it all depends on how competent that tech or QMA and if they understand the parameters involved.

So i'm wondering, how would having to do all the blood sugar checks have made you less busy? If you're too busy to follow up on them being done, doing all of them is only going to make you even busier!

LVN-RNhopeful

Specializes in ED/TELE. Has 9 years experience.

At my last hospital (I'm currently not working) our Techs did our accu-checks, and I felt very comfortable allowing them to do so. All of my techs were very prompt in reporting any abnormals. On an average night 3-4/5 of my pt's were accu-checks and I can't imagine not having my techs' help. I was very grateful for all their help and always made sure they knew how much they were appreciated. Trust me - just because an individual is licensed doesn't mean they are competent. I've worked with some RN's and LVN's that would send me running screaming from my room if I were a patient and they walked in and introduced themselves as my nurse.

I am PRO CNA's/assistants taking the blood sugars of their assigned patients. We are not asking CNAs to interpret or treat a high or low blood sugar or to teach patients, so I see nothing wrong with delegation of that task. I am thankful to be assisted in this way.

I do believe that there should be a standardized rule that if a blood sugar is reported as greater than 210 or something or lower than 60 that the RN should re-take the blood sugar if pt is asymptomatic, obviously treat if emergent or symptomatic. If my patient is talking to me and seems fine and I was just told his blood sugar was 11, you bet I am calling for that glucometer and doing it myself.

And if you are AGAINST CNA's taking blood sugars and say that youre too busy to recheck the blood sugar if it falls above or below a certain point--what makes you think taking all of your patients' blood sugars will take you less time? What next, do we analyze our own CBCs too because we are anal and the lab tech may not be?

Requiring a nurse to take a blood sugar may be an issue of patient safety, but what a simple task it is.. how many things could I be doing that we cannot delegate to a CNA in the time that it takes me to do 4 or 5 blood sugars?? Could I do my assessments a bit more thoroughly? Could I be doubly sure to adminster the right meds, right dose, right patient, etc? Might I actually make a med pass on time? the list goes on!

Thank you CNAs!

Roy Fokker, BSN, RN

Specializes in ER/Trauma.

My old hospital, techs were permitted to insert foleys and do accu-checks.

Now in my ED (different state), techs can do accuchecks - no foleys.

cheers,

it is entirely dependent on the "quality" of your tech.......the computor linked glucometer is also a good thing...makes it harder to lie. I think most of us can remember a tech or two, lying about VS or something else...if not personally, it has been mentioned here at AN more than once......the last two hospitals that i worked at (none particularly recent) the techs did routine blood sugars.....but they were long term, well trained, ACCOUNTABLE sorts of persons......Out of curiosity, on what basis did the NY bon decree this?

criticalHP, MSN, RN

Specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.

Michigan

criticalHP, MSN, RN

Specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.

Michigan is mixed. I've worked at big hospitals that allow techs to do fingersticks, and small ones that only the RN do figersticks. I have always found it frustrating that some techs would not report hi or low to me, but would chart it. While charting a hi or low is required, a verbal on all critical values is also reuqired-do all techs kow this? Apparently not. I think RN's should be responsible to obtain fingersticks- it is ultimatley going to require the RN attending to the pt, and in this way it is done without delay in needed treatment.

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

Michigan is mixed. I've worked at big hospitals that allow techs to do fingersticks, and small ones that only the RN do figersticks. I have always found it frustrating that some techs would not report hi or low to me, but would chart it. While charting a hi or low is required, a verbal on all critical values is also reuqired-do all techs kow this? Apparently not. I think RN's should be responsible to obtain fingersticks- it is ultimatley going to require the RN attending to the pt, and in this way it is done without delay in needed treatment.

99% of everything with a patient requires the attention of the RN ultimately.

Tait

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Our aids can't do fingersticks, but we actually draw a plasma glucose off of the patient's line for most of our glucoses.

WalkieTalkie, RN

Specializes in CVICU.

Our aids can't do fingersticks, but we actually draw a plasma glucose off of the patient's line for most of our glucoses.

Heh, your lab must be a lot faster than ours... or do you actually have a bedside machine that can interpret plasma glucose instead of whole blood? If we ever have to draw hourly glucoses, we are usually drawing another one before the first one's results are even posted. *sigh*, I know, and I do work at a major medical facility.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

75% of our patients in the ICU have Q1-2 hr glucoses, and if they are not Q1-2, nearly all patients have at least Q4-6 hr ones. Thankfully our techs do them. I couldn't even imagine trying to keep track of everything else I do and be doing hourly finger sticks. I certainly don't mind doing them if the techs are busy, but there are simply too many, especially when my patient is on an insulin gtt.

The techs take competencies/training on this, and know when to alert the nurse, and most of them are very good about this. The glucometer is also uploaded wirelessly and its results will show up under our patient's lab values in the computer. The techs also write them on a strip of paper taped to the inside of the patient's door. I rarely have problems with techs taking glucoses, and they are able to do them in a much more timely manner than I would be able to do... especially if one of my patients is occupying a lot of my time.

How many patients do you have? I usually have 1-4 patients and definitely have time to do my own glucoses, even for those on insulin drips. Our insulin drip protocol has recheck frequencies from 20min to 3 hrs. Even for our drip patients, if they have a central line we draw the blood for them off the line. It's just much nicer, and much less of a bleeding risk in our thrombocytopenic patients. I know was generally have less drips than a typical ICU, but we still have some very med-heavy patients and I've never found it to be especially burdensome to get my own glucoses. I'm in the room hourly doing something anyways.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

Heh, your lab must be a lot faster than ours... or do you actually have a bedside machine that can interpret plasma glucose instead of whole blood?

No, we send them to the lab. We generally get results in 15-30 min. The 2 hours when AM labs are being drawn are the only time the lab is slower than that, generally. Our patients with actual unstable glucoses are generally on insulin drips (then we draw blood off line and run on glucometer). Our q6h glucose, SSI patients are generally just occasionally hyperglycemic from TPN and/or steroids.

the RNs have always done them here.

WalkieTalkie, RN

Specializes in CVICU.

How many patients do you have? I usually have 1-4 patients and definitely have time to do my own glucoses, even for those on insulin drips. Our insulin drip protocol has recheck frequencies from 20min to 3 hrs. Even for our drip patients, if they have a central line we draw the blood for them off the line. It's just much nicer, and much less of a bleeding risk in our thrombocytopenic patients. I know was generally have less drips than a typical ICU, but we still have some very med-heavy patients and I've never found it to be especially burdensome to get my own glucoses. I'm in the room hourly doing something anyways.

We have 2 patients. We are not allowed to put "safe sets" on anything but arterial lines (guess our central line infection rates were going up from people improperly utizlizing it or something).

I work in a pretty high acuity unit, so it's not unusual to have a patient with a balloon pump in one room and a patient on SLED in the next, each having vasopressors which need to be titrated. I will often do my own glucoses if I'm not constantly running back and forth between the two rooms. Of course, the more pressors I add on, the more unstable the patient's sugars become, and it's also not uncommon for both patients to be on insulin gtts with Q1-2 sugars (Q2 after stable x 4 within the 70-120 range).

From what I understand, both of the situations above would be 1:1 at a lot of facilities? The only time we have 1:1s is with citrate SLED, ECMO, and our fresh heart transplants, or if someone is extremely unstable. When I have one of these patients, I will always do the glucoses because it only makes sense :)

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

We have 2 patients. We are not allowed to put "safe sets" on anything but arterial lines (guess our central line infection rates were going up from people improperly utizlizing it or something).

I work in a pretty high acuity unit, so it's not unusual to have a patient with a balloon pump in one room and a patient on SLED in the next, each having vasopressors which need to be titrated. I will often do my own glucoses if I'm not constantly running back and forth between the two rooms. Of course, the more pressors I add on, the more unstable the patient's sugars become, and it's also not uncommon for both patients to be on insulin gtts with Q1-2 sugars (Q2 after stable x 4 within the 70-120 range).

From what I understand, both of the situations above would be 1:1 at a lot of facilities? The only time we have 1:1s is with citrate SLED, ECMO, and our fresh heart transplants, or if someone is extremely unstable. When I have one of these patients, I will always do the glucoses because it only makes sense :)

Yeah, definitely sounds high acuity. Hope I didn't sound like I was accusing you of being lazy or anything, because I definitely didn't mean it to sound like that.

I'm not familiar with a "safe set." Do you not typically draw blood off central lines?

WalkieTalkie, RN

Specializes in CVICU.

Yeah, definitely sounds high acuity. Hope I didn't sound like I was accusing you of being lazy or anything, because I definitely didn't mean it to sound like that.

I'm not familiar with a "safe set." Do you not typically draw blood off central lines?

LOL, no offense taken.

A "safe set" is an extension which connects to the pressure tubing. 10 ml of blood is drawn back into a syringe device and then locked off - that's the "waste." There are ports distal to this which blood can be obtained from with a syringe. The 10 ml of blood is then unlocked and flushed back into the patient, and then the fast flush is utilized to flush through the extension tubing. We don't access the central lines for glucoses unless it's at a longer time interval (like 4-6 hours) just because we'd be wasting 240 ml of blood a day on some of our poor patients... heh.

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