2 Nurses needed???

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We are having a "dispute" of sorts at our small hospital. For the longest time, we have not had a policy that 2 nurses had to verify amount/type of drawn up Insulin and Heparin. Many people think it's "old school" and not done any more while others think it is still a standard of care. We do not have a specific written policy although are working on one. What do you think? What is the policy at your hospital? Any comments would be much appreciated.

Specializes in Obstetrics, M/S, Psych.
Originally posted by KnitRN

It may be old school, but my inpatient oncology unit required two RN's to verify insulin, heparin, IV narcotics, and chemotherapy.

I can see the logic if an institution wants to adopt the policy to include all potentially harmful meds (isn't that everyting?) but to have one in place just to check heparin and insulin? Definitely old school. Checking doses that require a calculation is a great idea though. It's well known that most nurses a mathematicallly challenged.;)

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In the NHS Trust I work in, ALL IV's as well as IM medication are double checked. Even "just" to give IV fluids. This is policy and there are trust guidelines written specifically for it. Two signatures are required.

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Originally posted by CougRN

Do you all mean like in nursing school when your instructor looked at your syringe to insure you were giving the right drug and right amount? If so, wow, no this is not done where i work. Hopefully by the time you are a RN you can learn to give drugs without help.

:rolleyes: I don't know if you are trying to say that LPN's are incompentent to give medication without verification, but she was just saying that was their hospital policy. I don't care what your title is you still have to follow policy. In my 12 years of nursing I have seen ALOT of incompentent RN's and LPN's. I am an LPN and I am not ashamed of it. I would go up against your nursing skills anyday. People get their degrees according to life style, finances and many more things that can inhibit spending more time in college. Most of you RN's would not be able to function without us LPN's because then you would have to get up and do a little work.
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:eek: Hey Southernbelle, hold on now I don't think you want to go there. I'm not defending what Coug said, but for you to clump all RN's into one stereotype is just plain wrong. 90% of the hospitals I work at don't even hire LPN's because hospital policy limits what they are allowed to do. Unfortunately incompetence is everywhere, in every field. I and many other RN's have no one to depend on for help, and I myself work my ass off and I have saved many lives, and I'm proud of that. That's my job and I love it. But how dare you state that RN's would be lost without LPN's you are showing your ignorance and are being extremely disrespectful. If you have a problem with a post then you address that person. Show your knowledge and your professionalism, not your discriminating statements and stupidity.
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Where the heck do you find an available nurse that has time to come and check your heprin and insulin?I sure dont know where i d find the time to check other nurses?????With 7-8 very ill pts per shift.It would be nice if we could do it !!!!!!!!!!!!!

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there is no such policy where I work, however if I am giving an unusally high amount, I will double check with another nurse.

:cool:

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I work at a very large, world renowned teaching hospital. They gave up the

double check thing years ago. Also, I worked at several different hosptials as

as a traveler and none of them did the double check. Only in the small, rural

hospital, where I did my clinicals in nursing school, did two RNs have to check each other for things like insulin and heparin.

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Specializes in NICU, PICU, PCVICU and peds oncology.

Here's one for you. Recently we had a child in our unit who has a number of challenging problems related to CATCH 22 (di George syndrome) including failure to thrive. The kid also has a latex sensitivity. Went to the OR for a GT and fundoplication, coming out with a 14Fr silicone foley catheter in situ rather than the usual Bard gastrostomy tube. (What the heck does this have to do with two nurse checks?? I'm getting to it!) A nurse put all the GT meds for a whole 12 hour shift into the balloon port on the foley before being informed that it wasn't a med port!!:eek: Diuretics, chloral hydrate, Tylenol, omeprazole and a few others. Maybe we need to have two nurse checks for "right route" !! Now the balloon is shredded and snagged on the pursestrings, meaning another trip to the OR for this young child for endoscopy and removal of the distal end of the tube. Zoiks!

(See Signature Line... words to live by!!!!!!);)

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Gosh, doesn't this get really frustrating for all nurses...RNs and LPNs alike! After nearly 8 years as an RN I am s-l-o-w-l-y learningto not get so frustrated at the gazillion different ways of doing the same thing depending on where you work.

I've worked at places/with nurses that check and don't check. Bottom line is that you need to a) follow your institution's policy (for "CYA" reasons) and b) do something about it if you think your policy is outdated, inaccurate, unsafe or inefficient.

What frustrates me most is when I work agency somewhere or when I'm orienting at a new job and I ask something like "do you guys do such and such at this institution." Ineveitably I'll get some blockhead drama queen (or king!) who says "oh, you're ALWAYS supoosed to" do it this way. This always amuses me. Invariably I ask that troublesome question - why? - in part to understand the rationale, though lately (with certain people ;) ) I just love to watch their response. The ansewr I HATE is "because it's our policy." Knowing WHY we do things a certain way as nurses is just as important as knowing HOW!

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Originally posted by BrandieRNq

What is the policy at your hospital? Any comments would be much appreciated.

The only meds we do not double check are oral meds, excluding the anti-coagulants and steroids. They too, must be double checked. Anything IV, IM or S/C MUST be double checked, regardless of whether it is a narcotic or not.

Personally, I don't mind. The number of times on night duty where my mind is not completely at work, another pair of eyes has saved a patient as well as my license. It is so easy to make a mistake, so why not exercise a little caution when it takes so little time to do?

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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. We are smart enough to know what is normal and what should be rechecked.

You evidently haven't worked with some of the acute medical patients that I have. One pt I recall was on 80u Actrapid TDS with 120u of Protophane at night. Sounds insanely high, but that's what was required to keep this patient's glucose levels in the "optimum" range. No it's not a "regular" dose as you put it, but for some people, it's normal for them.

Yes we should all be smart enough to know what is normal etc but mistakes do happen and I personally would rather cover my own backside than lose my license over a med error that could easily have been avoided.

I respect your abilities and all that (as I do all of my colleagues until they prove themselves incompetent), but I'll have to agree to disagree with you here. It's not THAT stupid an idea.

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Specializes in ER, Hospice, CCU, PCU.

Not sure what our policy is but I always have my insulin doses checked. Also do that with a few Peds dosages of potentially dangerous drugs.

My motto has always been "Better safe than sorry"

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