question about insulin, heparin injections

Super_RN, BSN, RN · Aug 26, 2005

You only have one nurse per unit?! Glad I don't work there. It depends. A lot of nurses I work with do not check their doses with others. Is it a policy at my hospital? No, it's not. I very rarely have to give a heparin injection, usually I give Lovenox, which is a lower form. Lovenox is already pre-packaged in appropriate doses. If I only have to give a few units of insulin, then no, I don't check them. I check anything over 10 units with another RN, just to be doubly-sure. I think it all depends on the hospital.

:coollook: Jaime

stidget99 · Aug 26, 2005

At my facility, any critical medications given via injection of any form need to be double checked by another nurse including heparin and insulin cancer drugs etc. Now is it always done??? Nope.

MS._Jen_RN, ASN, RN · Aug 26, 2005

I give SQ heparin all the time-every shift- on over 50% of my patients- and have never double checked the dose. We give it for DVT Px so it ia always 5,000 units (1cc). If we are giving heparin for Tx not Px it goes IV, on a pump, and is a double check per policy. I'm with Super_RN on the insulin. It's not policy to double check, but if it's a large dose (ie over 10 units or regular) then I do double check. Just to be safe.

~Jen

hhrhrn41, RN · Aug 26, 2005

I'm doing lab right now on injections and we are being taught that when we draw up heparin or insulin we have to go to another nurse and have the dose and med confirmed. I have never seen that done where I work. In fact, there is only one nurse per unit so it's not possible that it could be done. Do you practicing nurses out there do that?

yes, it is policy where I work, but only for insulin injections. No matter if you are giving just 2 units of coverage or 30 units for a routine dose. In fact, not only do we have to sign our own initials on the MAR, whomever verified the insulin for us also has to sign their initials. Now not everyone abides by this...alot of the nurses I work with just say "okay whatever let me just sign my initials, i trust you". I really have a problem with this and I make sure that whoever I ask that they actually look at the type of insulin, the number of units i'm drawing up and if i'm giving the correct units that correspond with the insulin sliding scale(if they have one). No one is perfect and everyone can make a mistake with giving any po med also but with insulin there is just too much chance of an error and why would you want to risk a patient just b/c you were to lazy to take 10 seconds to double check someones insulin!!??? As a matter of fact, just the other day after checking a patients glucometer, i looked at their sliding scale and determined how much insulin I would give them based upon their reading. when I asked a coworker to double check for me she said "just give it..I'll sign my initials." I made her double check me and here the patient really didn't need the coverage after all. If I would not have insisted that she check it(as per policy) I could have put this person into hypoglycemia. I guess where I work i'm a rarity in that i believe in following policy especially if something drastic happens. if you don't follow policy, you're basically scr*&ed and on your own. The hospital will not protect you!!

JentheRN05, RN · Aug 26, 2005

yes, it is policy where I work, but only for insulin injections. No matter if you are giving just 2 units of coverage or 30 units for a routine dose. In fact, not only do we have to sign our own initials on the MAR, whomever verified the insulin for us also has to sign their initials. Now not everyone abides by this...alot of the nurses I work with just say "okay whatever let me just sign my initials, i trust you". I really have a problem with this and I make sure that whoever I ask that they actually look at the type of insulin, the number of units i'm drawing up and if i'm giving the correct units that correspond with the insulin sliding scale(if they have one). No one is perfect and everyone can make a mistake with giving any po med also but with insulin there is just too much chance of an error and why would you want to risk a patient just b/c you were to lazy to take 10 seconds to double check someones insulin!!??? As a matter of fact, just the other day after checking a patients glucometer, i looked at their sliding scale and determined how much insulin I would give them based upon their reading. when I asked a coworker to double check for me she said "just give it..I'll sign my initials." I made her double check me and here the patient really didn't need the coverage after all. If I would not have insisted that she check it(as per policy) I could have put this person into hypoglycemia. I guess where I work i'm a rarity in that i believe in following policy especially if something drastic happens. if you don't follow policy, you're basically scr*&ed and on your own. The hospital will not protect you!!

Prior to my previous job (the one I just left) I had NEVER seen a hospital with that policy. I thankfully never had to give either while I was working there, I was just sure I would forget to check it with another nurse and get in trouble for it.

pricklypear · Aug 26, 2005

I was taught to double check in nursing school, all the nurses in the hospitals where I did my clinicals double checked. I've never heard of double checking heparin. I'm in a different state now, and the first hospital I worked at never double checked. Now our Pyxis is set up so you can't take insulin out without a co-signer. Talk about a pain in the A**. I do double check some cardiac meds, though - just to feel safer.

leopold · Aug 27, 2005

Thanks. It makes a lot of sense to me to double check but the fact that the facility I worked in didn't made me kind of worried that that was the norm and I would be thrown into a situation where I would have problems with that. I will definitely avoid facilities where there is only one nurse per unit!

lsyorke, RN · Aug 27, 2005

I've never worked in a hospital that required a double check on insulin. Seems to me if you can't draw up the proper amount of insulin you shouldn't be giving meds. Why would you need to be checked on insulin and not any other drugs? Makes no sense to me.

All_Smiles_RN · Aug 27, 2005

I'm a student, and both hospitals that I've had clincals at have required two RNs to verify insulin.

duwah · Aug 27, 2005

current facility requires insulin checking. I have also worked facilities where you checked both. While I find this inconvenient I also find that I perhaps check myself a little closer....and that can't be all bad.

Have seen several large med errors with heparin drips...and think that it is not inapropriate to have this rechecked by another nurse whenever possible.

button2cute · Aug 27, 2005

I'm doing lab right now on injections and we are being taught that when we draw up heparin or insulin we have to go to another nurse and have the dose and med confirmed. I have never seen that done where I work. In fact, there is only one nurse per unit so it's not possible that it could be done. Do you practicing nurses out there do that?

Hello, All

I agree with the "double check" policy, regardless, if a hospital requires it or not. Heparin is a dangerous drug if it is given incorrectly. I have learn from experience.

When I was a patient at hospital and the physician order heparian sq after my tah. Three nurses gave me the heparin and I told each of the that I had it once. they told me, I did not and I was lying. Well, I develop stomach pain, and it would not stop at all. I hit the pump and no relief. I was screaming and I could not deal with the pain. The physicians and surgeons arrived and I had developed a grapefruit size of a blood clot. They wanted to rush me to surgery, however, my blood was too thin and I was bleeding out. Finally, the decision was to let the blood clot to grow, it would stop the blood going into the abdominal cavity and have surgery later in the morning. By the time I left the hospital, the blood clot was a size of a basketball and hung down between my legs. They wanted to put a slice into the incision to relieve the pain and strecthing of the skin. The gyn told them my body would naturally open the incision to allow the blood clot out.

It did and the blood shot up into the air to the wall, on the chair and it stunk. I was rush to the er, they cleaned me out and it was painful. They squeeze, poke, and sweep out the blood clot. It was gross, foul smelling and dark blood.

I have learned my lesson about the draw up from heparin and how it can harm a patient, personally.

In conclusion, make the time for patient safety, checking the order and drawing up the medication and lastly, have someone to double check your work and it is not a trust issue, it is a safety issue for the patient and you.

Have a great evening,

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