wildlaurelrn

Our ED protocol is to start with 2 boluses NS to try and get the BG down. Then we reassess. If the patient is still hyperglycemic or in DKA (an anion gap is more diagnostic than the BG...you can have a BG of 220 and be in DKA) then we start the drip. We use a computerized program and when/if the patient eats, we plug the number of carbs into the program and it adjusts the drip. We check BG hourly and once the patient reaches 200, we continue the drip but switch them over to D51/2NS until the BG is down around 140. Then we start basal insulin and d/c the drip. It works well, you just have to stay on top of the BG checks, but the computer program alarms. You also have to watch their K+ because depending on the patient it can be really high or really low initially and once you start the insulin, it will change over several hours. Also, it doesn't make sense to me that a doctor wouldn't be concerned about an elevated BG because that is what causes the acidosis. If you can correct that - you'll correct the DKA. Here's a good article about hyperglycemia: Medscape: Medscape Access

I say it's a HIPAA violation, but my manager says it's not because the interns sign confidentiality agreements...but they're still not directly involved in patient care and don't need to be in the room to evaluate customer service necessarily. It'd be different if they were a nurse or medical professional there to ensure competency (e.g., when we're checked off on things like portacath access or NG tube placements), but this has nothing to do with actual patient care.

Our department management has agreed that nursing staff will be observed by interns who work for the marketing/customer service department within our organization. The observations are meant to see if we are providing customer service and we have been told the observers are going to accompany us into patient rooms when we examine them. I am uncomfortable with that and believe we should at least get the patient's permission. These aren't medical or nursing students - they're college kids getting a degree in marketing. If I was a patient, I wouldn't want them in the room when I'm discussing my personal health issues. Does anyone else see a problem with this? It isn't as though it's a nursing or medical student who needs to be present to learn about their profession - these people aren't there to learn about patient care - it's an HR observation.