Would you hold Metformin fot a BS level of 149

Nurses Safety

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I personally wouldn't. Then again, I am a new nurse. We all know that normal BS levels are 60-100. So, the paitent was hyperglycemic. My supervisor told me to hold the Metformin for this BS reading " in tand put "held due to low BS reading of 149" in the pts chart. Is she full of it? Trying to sabbotage me?

A nurse does not need a Doctor's order in any state to hold a medication. The Doctor should always be notified of your decision, but the final decision on whether or not to give a med is up to the Nurse. The Doctor is free to give it themselves if they can't convince the Nurse to give it. Determining the appropriateness of any medication when administering is within the scope of RN in every state.

No statement so broad can be taken seriously without at least a footnote, or a few hundred. And the word doctor is a common noun, not capitalized, as is the word 'nurse', that you at least also chose to capitalize on most occasions. That said, do LPNs also have the same, broad authority to hold meds, despite orders to the contrary? Please provide a source, either way.

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As I said, I am a new grad. When I took this job, I had hopes of being mentored. This relatively small error, well its a very simple thing that a Don should know I would think. I have only gotten 3 days of training at this place before I hit the floor alone. It was last week when I told my supervisor I don't feel too comfortable being on my own yet. It's not bc I don't believe in myself, it's that I feel like I haven't been given enough of a chance to get familiar with the surroundings , paperwork, and protocols. I was dismissed and just yesterday got my hrs cut from full time to contingent. Btw one of the things I voiced my concern over was a pts B.S. level of 35 during my 1st day on the floor alone and thx to God she had glucagon available on her cart. They hadn't even shown me where that stuff was. No apology, no responsibility on anyone's par t. She said well why didn't you ask before. Lol maybe its cuz a new grad might not have the experience to ask for info that should be given automatically

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Specializes in orthopedic/trauma, Informatics, diabetes.

i would only hold if not eating. I have had pts tell me they are really sensitive and I go with what they say. There is no reason to hold for 148 if everything else is normal.

If we do hold something, we are allowed to use our nursing judgement, we notify the physician and then if they want it given, we give it. I have that happen with BP meds and borderline BPs

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I'd hold it based on the ordered parameters given by the physician. And if there were no parameters, I'd call the physician to obtain some. It's quite the long-term time and liability saving thing to do.

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Specializes in Emergency/Trauma/Critical Care Nursing.

Just a side note, Metformin is also prescribed for non-diabetics for things like polycystic ovarian syndrome and weight loss, so if a non-diabetic doesn't become hypoglycemic every time they take it, I highly doubt someone with a BS of 149 would.

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Specializes in ICU.

I agree with you, Sam J. If I hold a med, I inform the doctor. I can certainly make nursing decisions and nursing judgment calls, but I would never withhold a prescribed medication without telling the doctor. My hospital strictly forbids this anyway. (If we do hold a med, we have to write a valid reason why it was held, who we told, and what the prescriber said when we called.)

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Actually, it is the nurse to patient ratio rather than the experience and knowledge of the nurses that affects pt safety more.

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Specializes in nursing education.
Actually, it is the nurse to patient ratio rather than the experience and knowledge of the nurses that affects pt safety more.

I know that staffing ratios do affect quality of care, and so does education (I suppose educational level could be considered a surrogate marker for knowledge)- here is a handy snapshot of educational level's effects on patient safety American Association of Colleges of Nursing | Creating a More Highly Qualified Nursing Workforce. I don't know of any studies that compare safety effects of staffing ratios and experience/knowledge head-to-head though. Ruby Vee might know of some.

I think the OP is doing a great job of questioning the current practice at this facility.

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Specializes in Pediatrics, Emergency, Trauma.
Any of these reasons, or a creatinine level over 1.5 (males) or 1.4 (females)- source Use of Metformin in the Setting of Mild-to-Moderate Renal Insufficiency

Keep in mind that Metformin is NOT A HYPOGLYCEMIC. It increases the body's sensitivity to insulin (either endogenous or exogenous) and prevents the liver from inappropriately releasing glucose into the bloodstream.

So it would appear your supervisor is indeed misinformed about the actions of this medication.

I was about to post THIS. ^

I never held Metformin for a BG issue; it's not approached as insulin for a sliding scale; it is for daily use. I would "gently enlighten" your supervisor the information that hey_suz linked. :yes:

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Specializes in Pediatrics, Emergency, Trauma.
No statement so broad can be taken seriously without at least a footnote, or a few hundred. And the word doctor is a common noun, not capitalized, as is the word 'nurse', that you at least also chose to capitalize on most occasions. ****That said, do LPNs also have the same, broad authority to hold meds, despite orders to the contrary? Please provide a source, either way.

As a practicing LPN prior to becoming a LPN, yes, LPNs use nursing judgement, and holding meds IS a part of nursing judgement; the collaboration of contacting a

provider to give an update and rationale to inform them and "suggest" to hold is something that ALL nurses are able to do.

IF the physician wants the medication given DESPITE the patients' apparent appearance and assessment, Muno is correct, they can come in and give it; usually if it gets to that point, soliciting the supervisor or DON is the best bet FIRST if a nurse is not comfortable with administering the med based on assessment when the physician wants the treatment to

continue.

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Specializes in Psych ICU, addictions.

For a BG of 49, I would have held it. But for your patient's 149, I would not--I would have given it as ordered.

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Specializes in Psych ICU, addictions.
She said well why didn't you ask before. Lol maybe its cuz a new grad might not have the experience to ask for info that should be given automatically

I say this with all kindness, but you really need to drop that thought process if you expect to suceed as a nurse.

You are a new grad but you are now also a nurse practicing under his/her own license. You're not under the umbrella of your CI anymore, and your supervisor has her own license and has no liability for yours.

Therefore, it is on YOU to know your facility's P&P, on YOU to learn about your job, on YOU to keep up your knowledge base--on your own time if need be--and on YOU to speak up if you are not sure about something instead of waiting for them to come to you with the info. Because if (heaven forbid) something happens to a patient and you end up having to answer to the BON, the "I didn't know, I'm a new grad so they should have told me!" excuse isn't going to fly with them.

The BON is NOT the nurses' friend. They care about protecting the public and not nurses, even if they are new grads--there's more than enough threads here that can attest to that fact. You'd be wise to adjust your thought process now before something bad happens and you're the not-so-proud owner of a disciplined license.

So don't be afraid to ask questions. Better to ask a question that you think is stupid than to not ask one and miss something critical.

Look out for yourself and your license. Because no one else will...ultimately the responsibility for your career and your license is yours.

Good luck.

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