2 Nurses needed???

askater11 · Mar 20, 2003

I've worked at 3 hospitals. 2 suburban/1 city. None of the hospitals have the protocol for heparin/insulin check by another nurse.

I'm very careful when giving any R.X. I check things 2 to 3 times. If I have the smallest question in my head...I don't hesitate to ask a pharmasist or another nurse.

Nurse Ratched, RN · Mar 20, 2003

Again, it's not about being a bad nurse - it's being a thorough nurse. It isn't policy at my facility, but I ALWAYS have another nurse look at the syringe. I would worry much more about a nurse convinced of his/her infallibility than a nurse who recognizes that human error does exist and goes out of the way to minimize it.

AHarri66, BSN, RN · Mar 20, 2003

Originally posted by CougRN
Give me a break. If you don't have the sense to know that 40 units of insulin isn't a regular dose and you should check the order then you aren't paying attention.

Gee...I've had patients on 40 units of NPH before, nothing unusual about that. :rolleyes:

Also, we had an incident not too long ago where the order was transcibed in such a way that the "U" for units looked like a "0" in "40". It spurred changes in our transcription protocol, as well as in the way MDs are required to write the order.

Our policy requires double-checking insulin and heparin, also, both gtt and sq. We only have to sign off on the heparin gtt. We double sign off on PCAs and epidurals as well.

Personally, whenever I give IV digoxin (or any other IV cardiac med), I have another nurse check my calculations just because. No one is perfect, even nurses, and my patients' safety is far more important than my ego.

emily_mom · Mar 21, 2003

Originally posted by CougRN
Give me a break. If you don't have the sense to know that 40 units of insulin isn't a regular dose and you should check the order then you aren't paying attention. I do agree that having certain gtt rates checked with peers is a good idea. But come on now, do you really need someone to check your insulin dosage before you give it? If it is out of the ordinary then yes, check the order. But a normal dose of insulin you should be able to handle yourself. If you are in such a hurry to get home and don't stop to think about your patient then I hope I don't have to work with you. We all need to focus on our jobs and really think about what we are giving our patients. You shouldn't have to have someone else always checking your dosage. We are smart enough to know what is normal and what should be rechecked.

Simmer down. My God.

It IS protocol at my facility (and the two before that), and we all abide by it. What is the difference of 15 seconds to prevent a serious med error? Some nurses don't have the best sight, and the syringes are small. I've caught a few near misses because the RN/LPN drew it up wrong. It happens.

:rolleyes:

surgorthonurse · Mar 21, 2003

Old school or not...Is 10,000 units of heparin or 2 units of insulin worth throwing your career away for???

If so I hear Burger King is hiring...

emily_mom · Mar 21, 2003

I'll have a Whopper with no pickles please....:)

New CCU RN · Mar 21, 2003

We also always double check any heparin boluses, or sub q hep or insulin. For some reason, we don't check insulin gtts.

Anyhow, these aren't the only meds that i will often check with another nurse. Every nurse is a person and we are all gonna make a mistake. If you honestly think that you will never make one, it leaves me to believe

1) you are not a nurse yet, but a student, and you haven't been working out there yet

2) you are a nurse but you are one scary nurse, who is gonna make an even bigger mistake then the double checkers out there.

When you need someone to back you for whatever reason, and Coug your day will come.... I'd rather have someone else on my unit being able to verify that yes I did give x amount of a drug.

New CCU RN · Mar 21, 2003

Oh.... and i have also had patients get up to 50 u of NPH... not all that uncommon... and not so hard to pick up a different insulin bottle by mistake....

kimmicoobug · Mar 21, 2003

Here in town, both hospitals also require a second set of eyes, though it is not required you co-sign.

CougRN · Mar 21, 2003

So NewCCU i have seen you on the CRNA board many times. So when you become a CRNA are you going to ask the circulator if you are giving the correct dose of Sux or Diprivan? I'm not saying I never ask for help because I do. But I also now how to do my 5 rights before I give any medication. I don't need a policy to tell me that before I give a med I should make sure I'm giving the right one at the right dose and so on. Think what you want about my skills but I am a very competent nurse and I know when to ask for help. But not every time I give a drug.

I have asked around my facility because I really thought this was odd. It is required on the floors, med/surg and so on, but not in the ICU's. Maybe it has to do with having a number of patients and trying to keep everything straight. I'm sorry but I had never heard of this and really thought it was strange. But no, i'm not a student and i'm not a scary nurse.

luvbeinganurse · Mar 21, 2003

At my hospital, we double check insulin and blood products. Both nurses sign off on the blood products, but not the insulin. There is no rule to double check heparin, but personally I think it's a great one - wish it was one.

TNcanNURSE · Mar 21, 2003

I have never worked anywhere that SUBQ heparin or insulin had to be double checked. We do have to be double checked on those meds if they are being given IV, but not SUBQ.

40 U may not be typical, but I have one patient whose dosage is in the mid 70's in the am, but then again she is noncompliant with her diet and is frequently seen downing sweets and Pepsi. :devil:

Her dosage is probably too high. On the rare occasion that she doesn't ingest massive quantities of sugar her accuchecks fall into the 20's. Personally I think they could lower her dose and change her BID accucheks with SSI to something more frequent. Things being as they are, she has to be watched like a hawk.