mtyfry

Yeah, probably.. I'll have to say that I haven't had much experience with hypoglycemic patients yet, but AFAIK Lispro onsets in 15 mins, peaks in 30-90 mins and goes out after 5 hours.. So maybe the bg levels had enough time to go up after 5 hours when the Lispro went out so the patient was back to normal when we were back for our day shift.. Or maybe that's not how it works.. Anyhow, yeah the funny/weird gut feeling is mostly right, but I can actually think of a few times at work when it's been clearly wrong for me too, so who knows.. Yeah, I guess I should count myself really lucky. Whatever the truth is, the patient is okay and now I got this realitycheck that will (hopefully) stop future errors and make me a better nurse! One annoying thing here is that for some reason doctors seems to like to put the patients on Insulin that we don't have, like NovoRapid instead of Lispro and Insulatard instread of Insuman Basal, and those doesn't show up as interchangeable on the computer so you have to go someplace else to see which ones that are. My first action is gonna be to nag to all my future doctors to make sure that while the patient is here, they should be on the same kind of insulins that we have in stock. All the different names for such a high-risk drug feel like another risk-factor for a mixup..

I will try to keep this short. So it was the start of this evening shift, I was preparing my meds and when I got to the Insuman Basal for one patient, a sudden dreadful feeling appeared as I felt that "this isn't the pen I gave this dose with last time". The other pen in the patient bin was, yes, Lispro... MASSIVE black hole opens up in my stomach. The last time I had worked with that patient group and given that insulin was a couple of evenings earlier. I remember giving the patient insulin at 8pm while the patient was eating a night snack, and then giving the patient night medicine two hours later. Nothing appeared wrong with the patient then. At 7 am the day after I get back for my day shift, and nothing appeared weird with the patient from the night shift, other than that "the patient had slept heavily and had been wet", nothing out of the ordinary for this patient.. The patient showed no signs of being unwell in the morning after or the rest of the day either. As the patient has been stabile in the blood glucose levels, unless something seems amiss we don't follow it regularly anymore (which isn't uncommon here). I did however check it the evening when I realized my possible mistake and it was okay, but of course that was several days afterwards.. Of course I feel like *** for the rest of my evening shift. Slept like *** that night, and the first thing I do in the day shift is go to talk to my boss and the doctor. As I really have no factual basis for any error other than my gut feeling they're skeptical, and as neither me, my colleague in the evening shift or the night shift nurses saw any signs of hypoglycemia with the patient which should have appeared rather quickly after such a large dose of Lispro (we're talking 3x the usual dose for the patient), they told me that they logically thought it's unlikely that I mixed them up. They probably saw how enormously shakingly I was and that I had realized the full scope of my possible mistake and learnt from it, so they told me that the important part was that the patient was okay, that I had told them asap and didn't try to hide it, and that I should try to move on. So yeah, here I am now. I know that logically we probably should have noticed something amiss with the patient, and that my memory could be playing tricks on me, but my gut still tells me that I could have given the wrong insulin, and that maybe the deep sleeping was that the patient was actually hypo... I know that giving too much insulin/wrong kind is one of the most dangerous things you could do as a nurse. I'm just so happy that the patient is okay, I don't think I could go on if I would seriously harm a patient like that. I'm never ever giving any insulin without seriously cross-checking it a million times. I'm probably never gonna find out whether I actually did wrong or not, but to ever move forward I feel like I need to use this in a positive way, by preventing future mistakes from happening. Double-checks and bar codes is unfortunately unheard of here. All kinds of tips and suggestions that I could raise is welcome!