nurse's aides doing accuchecks

talaxandra · Oct 7, 2004

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.

CarVsTree · Oct 7, 2004

I think someone forgetting to report a blood sugar could happen with any amount of training. The problem is if the RN took the sugar, she'd know right away and wouldn't have to remember to find someone for the result.

I am a NA and we do accuchecks. I'm given the room/bed. I take the check, right it on my VS sheet and give to the nurse afterwards. On one occasion, the nurse gave me the wrong # (well she says I heard the wrong #). I gave her the result (was written under the bed she "gave me"). Result was for different pt. than the one she thought it was. She covered based on that result. Fortunately for pt, we discovered error and she was covered for a BS of 180 when her real BS was like 275. So at least we weren't covering a high BS when pt actually had a low BS.

OP you were asking if NA's taking BS's is a problem. Do you mean is it a legal issue? What happened at your institution that caused it to be a problem?

jannecdote · Oct 7, 2004

PCT's do our accu checks. The only problem I have with it is when they get a blood sugar that is very high or very low and chart "Nurse aware" or "Nurse notified" when in fact, they have neither notified me nor made me aware of it. Their response to this is that the accu-check results are logged into a folder easily accessible to the nurses on the floor and since we know when the blood sugars are due, we can easily look into the book to see the results. I just have this nagging fear that I will be really busy and forget to look and .......well, you know the rest. :rolleyes:

mlolsonny · Oct 7, 2004

I'm in LTC and we use TMAs (trained medication aides) who are essentially CNAs who have taken a non-parenteral medication administration class. They are responsible for passing oral meds, eye drops, and nebs on their side of the NH. They are trained to check glucometers and have the information right in front of them in the MAR regarding when to notify the LPN (400 or if the resident is to receive sliding scale).

I have had NO problems with my TMAs. We have had a problem with an LPN who checked a glucometer after a meal and then gave sliding scale, which bottomed the lady out to 800), also didn't mention the change in mentation until giving end-of-shift report. Noc nurse send her out as fast as she could, but she died on the way to hospital.

Thank goodness that nurse is gone... Quit after our DON wouldn't allow her to check glucometers and administer insulin.

The right responsible CNAs can do just fine checking blood sugars, and they're the only one allowed to do them in our facility.

BTW, our PM shift TMAs are almost all nursing students (so they're already learning the theory behind the skills). I did it before I graduated and the experience was invaluable!

merricat · Oct 7, 2004

i did glucometers at one job (as CNA). the dON told us about one aide who had been caught not changing the sharp (i dont know technical term--pointer?) between pts. disgusting. should have gotten ability to practice as CNA revoked (we are regulated by BON here, which someone told me is not the case in other states). so i guess it all depends. i was okay with doing it though.

CarVsTree · Oct 7, 2004

The only problem I have with it is when they get a blood sugar that is very high or very low and chart "Nurse aware" or "Nurse notified" when in fact, they have neither notified me nor made me aware of it.

Well that is completely unacceptable. Are there repercussions for the PCT in this case? At our inst. If the result is >400 or

boulergirl, CNA · Oct 7, 2004

A couple of years ago I wrote management a note requesting an Accucheck kit because we had a diabetic who couldn't manage her own diabetes (she had dementia). I received a long response basically telling us, no, we could not test blood sugar because of the potential liability (to the facility). If she started acting funny, we had to call 911 and send her out.

Recently, one of our diabetics was sweating and shaking. The executive director told the med tech to take his blood sugar. She said we're not authorized, so the ED authorized her to do so. (Now this diabetic has a home health nurse.)

Basically the idea is, even med techs where I work are not allowed to stick people, PERIOD. This includes testing people for blood glucose. We are NOT licensed nurses. The med techs were taught how to draw an insulin shot, but the resident has to give themselves the shot, or home health does it. Med techs cannot actually give the insulin.

Nursenan0 · Oct 7, 2004

I have aides I would trust to do it and aides I wouldnt...but I also have nurses I wouldnt want to do things like that for me...I think its situational...our facility doesnt even allow the aides to do vitals :confused:

Whats with that?

Nursenan

PHTLS · Oct 8, 2004

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

That's because you've never had a patient go into a hypoglycemic shock. I have.

I also check my own blood pressures because I don't trust attendants taking my bp's while yapping on their cell phones. I CMA!

PHTLS · Oct 8, 2004

Here's another example:

Procedures and Policy states you should give insulin ac. I say screw that! I always give IT WHEN I see the pt eating.

NYCRN16 · Oct 8, 2004

I usually do my own accu checks anyway, because I dont trust anyone else (techs and nurses) to do them when *I* am the one giving the insulin. In my busy ED, the patients are moved around often, or are confused, and a variety of other factors that can cause the person doing the accucheck to take one from the wrong patient, ect. I am not saying that nobody knows how to do it besides me, but I think if I am going to be responsible for giving the patient insulin and for the outcome of that, to take the extra 30 seconds to do the accucheck is the responsible thing to do IMO.

lovingtheunloved, ASN, RN · Oct 15, 2004

In the facility where I work, we (CNAs) have to perform an accucheck for an RN, and demonstrate that we know the acceptable range for blood sugars, and the RN signs a form that is placed in our employee files. Only the CNAs who have done this can do accuchecks. If someone's bs is too low or too high, it doesn't matter who is screaming "I have to PEEEEEEEEEEEEEEE!!!!!!!!!!!!" The nurse gets notified yesterday. The nurses know which CNAs can be trusted and which ones can't.