nurse's aides doing accuchecks

Hey, here in Southeast Pa(Philly) pca's and na's are not allowed to do glucose in my institution. Nursing students and nurse externs are allowed to though. . .

Our techs in the ER do them after training. No problems as long as proper training is done. Lay people do them all the time on themselves at home, I don't know why trained personel in the hospital can't do so.

Only the techs that had been there for 3+ years are allowed to do them after training. I am a diabetic and have done mine since I was 6 or 7 with no real help so I do not see why a trained adult could not.

I work in a hospital in IL and techs do them as soon as they start working. I don't see what problem is, since people do them themselves at home. There really isn't much to accuchecks.

At the hospital I work at in VA, the nurses aides do accuchecks, and report the readings to the nurses.

My kids fight over whose turn it is to "stick me" - Even my 6 yr old can perform an accucheck - My kids help keep me compliant. One day while eating a snack, my 8yr old asked me if I was being 'naughty" or if it was okay to eat the snack!

At our hospital, our PCA's (patient care assistants aka nurse aides) do the accuchecks and verbally report the findings to the nurse. There has been no problem at all with this procedure. Yes, of course, they are trained first in how to use the machine. In our facility, it is part of the PCA's routine along with vital signs.

I'm in WA state...in the hospital I work in, the CNA's do the bedside blood sugers. But, technically by law, they shouldn't because it is an invasive procedure. The only way the hospital gets away with it is by calling it a delegated procedure. If you ask me it's no big deal...nothing a fifteen minute inservice can't handle.

I am in Texas and we(cna's) are not allowed to do glucose checks.

I am wondering what everyone else is doing in their ltc facility. We used to educate our cna's and supervise them doing accuchecks. Recently however, this has become an issue at our facility with the staff. What is correct? Where do I find an answer? I am from Pa. What are the rest of you doing?

thank you, Tracy

Only licensed staff should do them. Why? How would you like to draw up 10 units of regular Insulin and watch your resident go into a coma afterwards because some tech or aide didn't properly draw sufficient blood for the Accucheck machine to read?

You better get that juice or IM Glucagon ready.

I don't see nothing wrong with CNA's checking blood sugar but do with giving insulin.:)

Only licensed staff should do them. Why? How would you like to draw up 10 units of regular Insulin and watch your resident go into a coma afterwards because some tech or aide didn't properly draw sufficient blood for the Accucheck machine to read?

You better get that juice or IM Glucagon ready.

Only licensed staff should do them. Why? How would you like to draw up 10 units of regular Insulin and watch your resident go into a coma afterwards because some tech or aide didn't properly draw sufficient blood for the Accucheck machine to read?

You better get that juice or IM Glucagon ready.

Around here, I work as an aide and i do accuchecks all the time. Come on , they teach children to do their own diabetes care!!!!! The only problem I see is if some lazy aide made up the numbers like some do for vitals. But, around here each pt has their own meter with memory, so that might help.

Laura

The biggest concern to me is education. Like so many things in nursing, the actual task of checking a blood sugar isn't hard, but knowing how much importance to place on it is.

... [RN Jane] Storrs was caring for other patients with a clinical nursing assistant (CNA) who is, she said, a very conscientious worker. She simply has little health care background. The aide was trained to check diabetic patients' blood sugar levels...

The CNA did such a check on one of Storrs's patients and found that the woman had, in fact, a very low blood sugar. The unit then became very busy and the CNA neglacted to inform Storrs of this finding. Some time later, she bumped into Storrs and told her about the patient's blood sugar reading, adding nonchalantly, "But it's all right. It's not bothering her. She's sleeping."

The patient was not sleeping. She was gradually going into a diabetic coma.

"The aides are very well-intentioned. But the issue isn't good intentions," Storrs says adamantly. "It's education. they don't have it."

Suzanne Gordon Life Support: three nurses on the front lines 1997 p. 273

This example took place in an acute hospital, and it could perhaps be argued that patients in residential accomodation are less acute and therefore less likely to have unstable blood sugars. However, we've all known labile diabetics, and it's not like long-term care facilities are less inclined to get busy than wards are, even if it's a different kind of busy. Given that graduate nurses often have a lot of difficulty shifting priorities as the situation changes, it's not hard to see that this could be even more the case with aides.

I'm not in any way dumping on nurse aides, and I'm certainly not saying that CNA's aren't valuable. it's just that the less one knows the harder it is to tell what emphasis something needs.

Giving parameters doesn't always resolve the situation, either - I worked with a Division 2 RN (roughly the equivalent of your LVNs, I think) a few years ago. She had worked for a while in rehab, and had very good clinical skills. One afternoon I was flat out with one unwell renal patient - literally spent the entire shift with him (no tea break etc). At 2110, when he finally went to theatre, I headed up to handover to the night staff. It was then that I discovered that my ICH patient, who was on 2/24 neurological obs, had dropped his GCS from 13 to 7 over the course of the afternoon. My colleague knew to report a drop of more than 2, but didn't realise that this level of decline over eight hours was a problem; urgent CT showed no change, therefore probably infarct, went to ICU but as he couldn't be anticoagulated and there was no point having a craniotomy etc, they couldn't do anything and he died the next day.