2 Nurses needed???

[BrandieRNq]

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.

[Rustyhammer]

I think the practice began when there was U-80 and U-100 insulins and the double check was to confirm the dosage of that.

I haven't seen anyone double check insulin with another nurse since I don't know when.

It is unecessary I think.

-Russell

[purplemania, BSN, RN]

Used to be practice, not policy, until a new nurse gave insulin in a TB syringe. Don't have a policy on 2 nurses regarding SQ heparin though.

[cathy949]

Strict policy in our hospital that all medications are double checked.

[kmrmom42]

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.

Even in nursing school it was made clear to me that this was not something being done just because I was a student. I was taught that this was appropriate in all situations due to the small dose and syringe. In our facility we do this and we also double-check other things like all neonatal meds, IV meds we mix ourselves and some rarely used meds.

I don't know how old you are but I am tempted to say "Wait until you are in your late forties like me and see how silly you think this is! The eyesight begins to fail!!"

[caregiver11]

This issue has been brought to light due to JCAHO recommendation on medication safety. Check out the JCAHO website.

[WhiteCaps]

We co-sign insulins & heparin tho it seems very "old school" to me also.

I double check dosages but we don't go to the bedside to be sure it's given to the right pt! Gosh! I hadn't thought before of the legal responsibility there!

Who's there when I'm setting up a PCA, Nitro or Natracor drips??

Shhhhhhhh! Don't anyone tell JCAHO what other meds we pass!

Hey, if they are REALLY concerned about reducing med errors, why don't they regulate staffing better so we're not so over-worked that mistakes are made?

[sbic56, BSN, RN]

I get so tired of hearing about JCAHO certification and how great it is. IMHO it doesn't improve patient care and only increases our workload with it's requirements, making our jobs even more stressful and difficult. Just a worthless status symbol and bunk to me. Adequate staffing is the only answer.

[debmsn01]

Yes it seems that JCAHO does make our lives hectic-for the 3 days they are present, plus the weeks prior to their arrival. Isn't it funny that the organizations are not concerned with those important points until they "need to be".

In response to whitecaps: I do make a point of double checking critical meds with another nurse, I have for 24 years, it covers me & makes sure the patient is receiving the correct dose. Taking a few seconds to do this seems like alot-until something happens. We become so concerned with delegating our tasks, doing the paperwork, & other things that we forget the important things that need critical thinking application. I know staffing is bad in places, I have taken care of 5-6-7 patients in one shift, WITHOUT a CNA, PCT or LPN to assist. I didn't like it, so I quit after 23 years in the same organization. Speak out, get yourself involved in your State's nursing organizations, look at UNIONS!!! I do not advocate unions wholely, but if it can help- GO FOR IT!!! Nursing must become responsible for ourselves, no one else seems to worry about us, & *****ing about it in the lounge or at home gets you no where.

[boopchick]

Originally posted by Julielpn

Heck! I can't even get the nurse going off duty to count narcs with me!!!!

Wow! Are you serious???

[Joycean]

I ran a poll on this subject a few months back and 65% of the responding nurses do double checks on insulin. Our hospital policy states double check orders and dosing when drawing up any type of insulin when dose is 20 units or greater. This is evidenced based by research done by our pharmacy dept.

[River]

When I worked in a hospital setting both insulin and heparin were double checked. But, interestingly enough in home health setting we give lots of insulin all by our little ol' selves.

[Geeg]

It is an outdated policy in regard to the insulin. Originally, the double check was because insulin syringes were not standardized. It was necessary to match the units that the syringe was marked off in was the same as that of the insulin vial. i.e. you'll notice that the all the vials say U-100 and so do the syringes. If the hospital does not trust us to draw it up correctly, then it stands to reason that everything we do needs to be double checked!!!!! Ridiculous.