2 Nurses needed???

Nurses Safety

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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.

Wow. OK..I am a student in LPN school right now. And I do not have the attitude that I'll never make a mistake. They happen...hopefully it won't be a mistake that could have been prevented by 15 seconds of double-checking.

I worked at a Urology office for a brief period of time. I did not stay there because I was uncomfortable due to lack of training. They hired me as an "MA" But I'm only a CNA at this time. When asked about blood draws and injections, the nurses just said "You take the needle, put it in and get the blood..not that hard." I just wasn't OK with that. And then my mistake came...Thank (insert higher power name here) that it wasn't a patient mistake. (I have to be PC these days..lol)

I forget the actual name of the drug now, but its for prostate cancer patients. Its given every few months IM. Its a pickey drug. Medicare won't pay for it if you give the injection 1 day before its due...and it costs like 1500 bucks each time.

Well, there I was with this bottle that had to be mixed before giving the injection. What did I do?? I sprayed 1500 dollars worth of medicine all over the floor. Why? Because no one took the time to SHOW me how to do it correctly. They just say "you do that, mix that and go."

So..my mistake in not actively searching out help, giving up, and trying to figure it out myself ended up in money lost. Tought me my lesson when it comes to asking for help.

I loved the job...but realized I needed more education to feel comfortable doing it....but I will ALWAYS double check when it comes to things I'm not 100% sure of...and as a student nurse...I'm trying to make habits out of double checking....

So...hopefully I won't end up in front of the Board of Nursing during my career trying to defend a dumb mistake that could have been avoided!! =0)

Jules

TNJ...Lupron?

Specializes in med/surg, cardiac/telemetry, hospice.
Originally posted by CougRN

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.

Coug, you obviously don't read things very closely, because this thread wasn't about every time a drug is given, it's about whether a hospital has a policy for double-checking certain drugs. Your inability to read something this simple could very easily translate over to a drug error.

Did you ever think that hospital policies are written because of research done into the causes of med errors??? Or is it because all of us other nurses out here are just not as smart or competent as you, and we never learned our 5 Rights???

:(

I have worked on the floors and in the unit in my faciluty and BOTH places require checks on insulin and heparin.

For heparing there is a stamp that we have to verify we did the math and sign off on. However, we DO NOT have to check the rate on the pump...so that is where I will see mistakes. A dose of a 1000 will be set on the pump as 20 instead of 10.

I would wonder why your unit does not have such measures in practice. In ICU/CCU where folks are very sick even a small mistake can be deadly.

Thats it!! Lupron!! I know they are amazinly expensive..my monitary estamite might be off....but holy heck!!

Specializes in Hospice, Critical Care.

It is not a strict policy at my place. It is advised and I frequently have my insulin double checked but not always (depends on who's around!).

It's even more of a good idea now, though, because they have changed our syringes. Both the tubercuin and the insulin syringes come in the exact same orange-color wrapping. It is very confusing! Our TB and Insulin syringes have always been kept in the same drawer on the med cart; TB has always been blue and insulin has always been orange. Now they are the same! Stupid, stupid idea!!!

It is policy where I work to double check both Heparin and Insulin. Old school or not I have always had someone double check insulin for me no matter where I worked.

Strictly enforced policy at my hospital.

Sometime in the late 80s thought was that if we taught patients to give themselves their own insulin and not double check that there was no reason for nurses to double check. Well, times change, things happen (sentinel incidents) and what looked like "old school" practice becomes standard practice again. I have worked places where insulin, heparin, dig, and a few other things were double checked and documented. Here and now, the double check is done but there is no documentation. In Peds, Nsy, NICU they double check all drug calculations. It does make sense.

With medication errors being a national patient safety issue, better safe than sorry.

I was shocked that so many people check insulin and herparin. I don't think it's wrong. I went to school in the same hospital where I work and have never read anything about checking with another nurse unless it's peds. On my floor we give a lot of both those drugs. I would be checking all night long. Let's say I have 8 patients. 5 probably get insulin if not more (many times over 20 units) and twice in my shift. Plus, this is the same for the other RN's, ouch that would be very time consuming. Not to say it wouldn't make things safer but it would take a lot of time. Then taking more time the RN's would be busier and rushing and probably make an error another way. I guess it work though if so many of you do it.

Do you mean you check SQ heaprin or just IV? We don't check either but SQ Heparin is given to like 95% of our patients. We give a lot of IV too, we have lots of DVT's. Never do we check with each other. The only thigs we check check with each other is blood and PCA's (that just started a few months ago). PCA's are co-signed when they are hung, changed or D/C. That policy was made because of so many errors. I have lost count on the amount of error I have found on PCA's, it's crazy.

I think if you have a lot of patients you should be checking more often. You definitely don't want to give one patient another's insulin or heparin dose by mistake.

Originally posted by CougRN

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.

The reason someone double checks is to ensure the right amount is drawn up, not the 5 rights. Humans make mistakes, and sometimes the wrong amount may get drawn up. Sorry if not everyone is as perfect as you apparently are. For your next act will you walk on water? Please?

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