question about insulin, heparin injections

thecitadel80 · Aug 27, 2005

I haven't worked everywhere but I have found it pretty consistent that insulin and anticoagulants must be cosigned. This is actually a pretty good idea.

BGgirl · Aug 27, 2005

We have handheld machines like palm pilots for our meds called the admin-RX. We have to scan ourself to enter the program, scan the med and then scan the patient were're giving the med to. We have to find another nurse to scan themselves to witness meds like lovenox, heparin, insulin etc. They say it's supposed to cut down on med errors and that most hospitals will be going to these eventually.

mak2 · Aug 28, 2005

We have BCMA and do not have to cosign anything but blood, but after all these years, I still show someone my insulin and repeat the order outloud.

mak2 · Aug 28, 2005

Has anyone read a study about anticoagulant med errors and some motivation for our management to change our procedures? I will bring this up but would like to have a study for backup.

jmgrn65, RN · Aug 28, 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?

We use to dble check with another nurse for insulin injection but have never with heparin we give it twice a day. on the majority of our pts.

Hoozdo, ADN · Aug 28, 2005

We use to dble check with another nurse for insulin injection but have never with heparin we give it twice a day. on the majority of our pts.

In my area, Phoenix, it varies on what the hospital policies are. In clinicals I have seen insulin checked in some and not in others. I have never seen heparin verifies as a subq, only on a drip. Speaking of insulin, last night I had a MAR that ordered 45 whopping units of Lantus on a pt. I wasn't about to give that until I physically looked up the order in his chart :rotfl:

Lu Ann

JCRN · Aug 28, 2005

Wow, it never occurred to me that one wouldn't have to have a cosigner. At my hospital we have to have heparin, insulin, and coumadin doublechecked, along with someone varifying any heparin drip or PCA pump that is set up. On the upside, I don't recall any med errors (at least that have been discovered on any of these meds)-knock on wood! :yelclap:

NannaNurse · Aug 28, 2005

We don't double check...........who has time? And you can never find the other nurses!!

Hep drips, PCA pumps...yes, anything other then regular IVF is checked.

For all the students out there.........you will find out that most of the stuff you do in clinicals are only done in clinicals.......NOT in 'real' life nursing. You will find that you don't have time or not enough staff.....or both!!

I could see with the insulin, but with heparin??

No wonder we are all so tired. We have to have every little thing checked and then double checked........whew!!! :zzzzz

epiphany · Aug 28, 2005

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,
Buttons

Hi Buttons:

First of, I'm so sorry you had to go through that. But I have a question concerning the physiology of what happened to you. If you were on heparin - probably too much heparin at that point - how was that clot continuing to form? One would think that the heparin might have prevented or slowed down a clot?

Does anyone understand this and can explain? Thanks.

gypsyatheart · Aug 28, 2005

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,
Buttons

OMG, Buttons!

Wow! What a horrific experience! I can not believe they actually let you go home w/a clot that size, especially after apparrent "med errors", and the possible repurcussions of what happenned. Also, let this be a lesson to any patient....you have the right to refuse a medication. If you told them you had already received the heparin, and they "acted as if you were lying" and gave it anyway :eek: :nono: ??? Wow! I have pt's refuse meds/treatments all the time.... I'm glad everything turned out allright, sorry you had such a bad experience.

gypsyatheart · Aug 28, 2005

We don't double check...........who has time? And you can never find the other nurses!!
Hep drips, PCA pumps...yes, anything other then regular IVF is checked.
For all the students out there.........you will find out that most of the stuff you do in clinicals are only done in clinicals.......NOT in 'real' life nursing. You will find that you don't have time or not enough staff.....or both!!
I could see with the insulin, but with heparin??
No wonder we are all so tired. We have to have every little thing checked and then double checked........whew!!! :zzzzz

Actually, I was taught to always double check insulin and heparin w/another nurse. Always. And in every facility I have worked in this has been the case. Some things really are the way the way they are taught in nursing school. Yes, it takes extra time, but it is certainly worth it. Medication errors are at an all time high, that is one of the reasons we are seeing all the double checks put into place.

button2cute · Aug 28, 2005

We don't double check...........who has time? And you can never find the other nurses!!
Hep drips, PCA pumps...yes, anything other then regular IVF is checked.
For all the students out there.........you will find out that most of the stuff you do in clinicals are only done in clinicals.......NOT in 'real' life nursing. You will find that you don't have time or not enough staff.....or both!!
I could see with the insulin, but with heparin??
No wonder we are all so tired. We have to have every little thing checked and then double checked........whew!!! :zzzzz

Hello, Everyone

I believe that our time is well spent by all things that are require by the hospital and patients. If the time is so overwhelming that one cannot double check insulin and heparin than something need to be done. A patient's lives are in our hands and if we do not hold thier lives with caution and prevent any mistakes from happening. Then we did not accomplish our goal of patient safety as well as the oath we had taken at graduation does not mean a thing unless they are carry out. Therefore, action is louder than words, one is never too tired f patient's .

Heparin can harm a person from thinning blood to killing a person. When adminstration this power medication, please have someone check this potent drug. No one like to have side efffects or be a vicitum or uncare, over and unpatience medical faculty. Thereoe, also, it is your conscious if harm comes to the patient.