2 Nurse Verification of SubQ Insulin

by Heide MedSurg Heide MedSurg (New) New

Hi -

I have been hearing that some facilities have dropped the need for 2 nurse verification of SubQ (not drip) Insulin. Can you let me know what your facility does? Thanks!

Lynker, LPN

Specializes in LTC, Rehab. Has 3 years experience. 228 Posts

I've been a nurse at a LTC for over 9 months, and I've never verified my insulins with another nurse. I do however, triple check the order and amount that is drawn up/dialed to.

NotMyProblem MSN

NotMyProblem MSN, ASN, BSN, MSN, LPN, RN

Specializes in Med/Surg, LTACH, LTC, Home Health. Has 36 years experience. 2,690 Posts

Two-nurse verification was the policy at several of the hospitals that I traveled to and/or was employed with. However, this proved to be time-consuming when nurses could not proceed with documentation until another nurse arrived to sign off on the drug. So, it stopped.

What I do in practice, though, is to review my patients' glucose levels and patterns (do they tank at a certain point; do low levels skyrocket if normal levels do not receive scheduled dosages; etc). Those patients whose results and reaction to coverage is all over the place always receive a two-nurse verification before I administer insulin, whether it is required or not....best to be safe, not sorry.

Even with the insulin-tolerable patient, if there is a nurse walking by or standing at the pyxis when I'm drawing the insulin up, I won't hesitate to ask for a quick eyeball.



Specializes in Critical Care. Has 12 years experience. 7 Posts

Two-nurse verification is our policy for SubQ insulin, but it was not at another organization I worked at.

Chickenlady, ADN

Specializes in ER, GI, Occ Health. Has 8 years experience. 142 Posts

Still do it


Loco-Bonita, BSN, RN

Specializes in CVIMCU/CVICU. Has 5 years experience. 65 Posts

I’m in a hospital and we do not do two nurse verification. We use SQ insulin pens, which help a lot.


OUxPhys, BSN, RN

Specializes in Cardiology. Has 7 years experience. 1,179 Posts

My previous job and my current job you do not need 2 person verification for insulin. However, when I am giving absurdly large doses I always double check with another nurse.

FolksBtrippin, BSN, RN

Specializes in Psychiatry, Pediatrics, Community, Nurse Manager. Has 6 years experience. 2,064 Posts

We do it.



Specializes in retired LTC. 7,735 Posts

I find it humorous that when I worked in a couple small facilities, I was the ONLY licensed nurse. Nobody to check double check with.

Problematic when wasting narc meds and then the 2-nurses for foley cath insertions (that was after my time), not to mention the insulins.

MiladyMalarkey, ASN, BSN

Specializes in Neuro. Has 3 years experience. 519 Posts

We do the 2 nurse verification


Katie82, RN

Specializes in Med Surg, Tele, PH, CM. Has 40 years experience. 642 Posts

I have not worked bedside for many years, but when I did, we were not required to check with another nurse. We never had staffing that would allow this. I did, however, verify the dosage (and the BG in the case of coverage) with the patient. I am now a Diabetes Educator, but even back then, I felt strongly about the patient being very involved in their own glucose management. I always documented the process.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 10 years experience. 3,069 Posts

We did a study/audit at my facility as they were thinking of doing away with the dual sign off. What we found is that the mistakes that were being made were not due to sign-off. They were, wrong route (Lantus given IV), wrong time, NPO vs eating, not following MAR instructions. We decided to keep it because there were enough of us that felt it was necessary in a teaching hospital and a high amount of new nurses.

I saw one NPO pt given not one, but 2 full doses of mealtime insulin. Which meant 4 nurses missed the NPO status, the time (NPO are Q6H, eating ACHS), and the amounts (omit dose it pt is not eating).

On my particular unit, the "mistakes" were very minor-we have a policy that BG cannot be more than 60 min old and we found a couple of 61/62 min admins.

I am continuing to find an outcomes based project to complete for my clinical ladder. We actually do quite well with our diabetes management.