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.

[howie122832]

Originally posted by MishlB

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?

My thoughts exactly!! Oh, yea, by the way, there are now 6 rights!

1) right med

2) right time

3)right dose

4)right patient

5) right route

6)right documentation

Always, always, always, have heparin and insulin and every other med that you are not sure of double checked by a second set of eyes!! It's worth that little extra time to do it, or you could spend that time later explaining why you screwed up!

[emily_mom]

Originally posted by Dr. Kate

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.

Right, but if a patient gives themself the wrong dose, it's their fault. If a nurse gives the wrong dose, it's his/her license.

Your last line says it all. :)

[MusicLuvnNurse]

When I became a nurse, my son had been diagnosed as a diabetic for ten years. By that time, I was very comfortable as well as knowledgeable about diabetes and insulin. I was completely shocked by the amount of questions i received regarding insulin. For example, one nurse came up to me and said "humalog is the same as nph, right?" i shudder to think what may have happened if she had given humalog as nph. Hopefully, she would have looked it up if I wasn't available. Anyway, it's only since being on the frontline that I realize diabetes and insulin can be kind of tricky if you're not used to treating it on a regular basis. What's the harm in double checking something that can have such severe consequences? Take care all..

[Hellllllo Nurse, BSN, RN]

I work in chronic dialysis. There, technicians (6 weeks on-the-job training) are permitted to give intra-arterial heparin, without a second or even a licensed person checking.

I disagree with the policy.

[Hellllllo Nurse, BSN, RN]

Also...

I have worked in LTC where the policy is two nurses check insulin, two sign off wasted narcs...But.. I was assigned as the only nurse in the entire facility.

Guess the people writing the policies need to take a look at staffing.

[NotReady4PrimeTime, RN]

In our unit ( a PICU), we are required to double-check and double-sign virtually ALL meds given, even PO meds. The current exceptions are ASA, acetaminophen, ibuprofen and vitamins. Every dose, every time. This is a huge problem at certain times of the day when there are few people on the floor, and when you're in isolation all by your lonesome. We've wondered what would happen if we had to tell our intensivist we couldn't sedate the patient who just self-extubated because there wasn't a nurse available to double check our chloral.

[bjfitzger]

I've drawn up one wrong insulin dose. When it was double checked it was found. We can all make mistakes and a little caution protects the patient, you and your employer.

[gwenith, BSN, RN]

Double checking some drugs ain't just policy over here IT'S THE LAW! Especially "schedule 8 "drugs. Routine all hospitals have a policy that ALL IV drugs (including IV FLuids MUST be checked by a second person. Some hospitals it is policy not only for two nurses to check ALL drugs but to countersign that they have been checked (oral included) they double check the lot!

[Chaya, ASN, RN]

Had the same problem as HelllllloNurse and Janfrn..Unwritten policy is for two nurses to check insulin syringes before subcu dose BUT the night nurses do the greatest numbers of fingersticks (about 12-14 at 7 AM) and there are only two nurses on the floor (and occasionally only one!). They are trying to give insulin as close as possible to breakfast, which is about 8, so they are usually doing it about 6:45, with the new shift coming on and redistributing the MAR's and patients all waking up SO this is when insulin syringes might not be double-checked, depending on how crazy it is...makes ya think.

[JillRene]

Hi! I'm new here! Love this site!!

As for the insulin, I'm a Travel and per diem nurse, I've worked at different hospitals and it varys. Out of habit I get it double checked along with Heparin gtt calculations.

Sad Story: My boyfriends mom broke her hip, went to Nursing home for 2 weeks after hospital stay for rehab. She was on sliding scale. LPN gave her 64 units Regular insulin!!! Do you believe this?? She stated she thought the u was a 4. I was so angry, never in my career have I given 64 units of Reg., and I've taken care of PT. on insulin gtts. My boyfriend had power of attorney so I told him to request a copy of chart. Here is the kicker, the Mar was typed, how could you possibly confuse a typed u with a 4. Needless to say with much sadness she was never the same after that, didn't recognize own family.

Attorney was contacted, still pending.

If it was up to me I'd have the LPN's job and license.

[jeanrnurse]

The last 3 hospitals I have worked at, as an Educator, had no policy on this, or have specifically eliminated it. We do regard it as "old school", & there are so many other drugs more dangerous. If you continue to do this for insulin, why not EVERY drug? It may be a good rule of thumb to double check those infrequently given or with unusual dosages, but putting it in a written policy sets the hospital up for litigation, if it is not followed in every case.

[KnitRN]

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