2 Nurses needed??? - page 6

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... Read More

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

  2. by   ruby360
    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.
  3. by   NotReady4PrimeTime
    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!! 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!!!!!!)
  4. by   jadednurse
    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to a) follow your institution's policy (for "CYA" reasons) and b) do something about it if you think your policy is outdated, inaccurate, unsafe or inefficient.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!
  5. by   OrthoNutter
    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?
  6. by   OrthoNutter
    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.
  7. by   debbyed
    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"
  8. by   jadednurse
    I guess my question to those of you who have to double check so many meds is do you guys document this somewhere? I think alot of places started requiring doublechecks on certain "high-risk" medications after some serious "boo boos" occured with patients. Certainly one reason is to protect the patients (no better reason than that I think!) but I'm sure another is to protect themselves from litigation. I think the catch here though is that if the institution doesn't require a co-signature to be documented they could open themselves up to alot of legal headaches should a major error occur. I worked at one place that made a huge deal about double checking heparin drips (after years of never having any such policy) but then never had a place to document a signature from the verifying nurse. Good system, but kind of incomplete in my mind.
  9. by   debmsn01
    As a 24 year veteran of nursing and now as a nursing instructor, I don't think this is about "old school". It is as many have stated, "good nursing care". By double checking your meds such as insulin & heparin, you ensure safe & efficacious care to a patient. I carry my PDA with me at all times & still look up many of my drugs to make sure of any interactions, concerns, etc.. If a mistake is made, you probably didn't mean it, but will have to live with the outcome forever and it isn't easy. I have many friends who suffer with "what ifs" because they failed to have someone check something & a sentinel event occurred. Another thing is narcs-have someone check them also, it will also cover you if someone is diverting-you won't be suspect.-Debb, MSN, RN, OCN
  10. by   tonchitoRN
    this is an interesting thread. although double checking is a great idea i think most people are so busy to go find someone to double check every med. now if you think 2 signatures are going to get you away from litigation, think again. if a mistake is still made then the 2 signatures get pulled into deposition so be careful when you check. remember, everything is about accountability. if you ask me to double check your work be prepared to show me the original order (no kardex), the bottle you pulled the med from, the syringe and the patient. then and only then can i verify that the 5 r's are being done. if you can't do that then find someone else to help you. i am protecting myself too, you know.
  11. by   debmsn01
    You are absolutely right, I would never sign or even verbally verify unless I see everything. Usually at the times of these meds, there are more than 1 nurse at a med station. I made a fellow staff member throw insulin away that was mixed & do it again so I could check each dose/type.
  12. by   mother/babyRN
    I have never worked anywhere where insulin had to be verified, although with anything like heparin, I always did so...
  13. by   CougRN
    Originally posted by southernbelle36
    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.
    Ok, I'm not sure what I did to you in a past life but this wasn't addressed to you. I wasn't even thinking about RN vs LPN because we don't have LPNs in my unit. Sorry if you took this personally.

    It has become apparent to me that I have offended a few people with my comments. Sorry, it was just my opinion but I guess that is not what this board is for. I will fall in line and regurgitate everything you all believe and not think for myself from now on. jk

    Anyway, I stated earlier that we as nurses should be able to read and order and know when an order is not "regular". what i was trying to say is that when an order appears out of the ordinary then i would double check or even triple check the order for verification. I'm not against checking orders because I do this all the time. I check my dosages and math every night. I just thought it was odd to have a policy in place for insulin verification. You will have to excuse me for being surprised by this.

    So in answer to the question originally posted, No we don't have a policy in place to double check medications in our intensive care units. Yes, we check gtts and medications with each other all of the time because we are safe and compitent nurses.