Reprimanded for giving glucagon?!!!

[dblpn]

Seriously I don't understand it. I work 12 hr. nights in LTC. so about 2am i went to check on my resident b/c it was reported from days that her bs was running in the low 50's. also she was asymptomatic of hypoglycemia. she was fine when i came on talking laughing just her usual self. i've been checking her bs and it was pretty much the same 53. i goes in and she was disoriented shaking etc. i took her bs and it was 23. i immediatly ran to call the md. there was no order for glucagon but we got it in the ekit and that's what i was going to give her. told the md what was going on and see if i can give the glucagon he said yes. i give her 1ml of glucagon IM. immediatly she started to come around. bs slowly was coming up and in about an hour she was 119.

of course i charted and reported to the next shift finished up my work and went home. i got a call later from the DON chewing my butt out for giving glucagon and she wasn't unconscious. i told her there was nothing else i could give her and i had the permission of her doctor to do so.

Was i wrong for doing this?

[MoLee228]

That's absolutely ridiculous. You did the right thing.

It's odd to me that the MD didn't want to address blood sugars in the 50's, even if she was asymptomatic. That does not leave much wiggle room before she is in serious trouble, as you encountered. Baseline in the 50's is not a good thing...

But seriously, you did the right thing. To NOT give glucagon in that scenario would be negligent, in my opinion. I would not have thought twice to even check for an order...I would just give it with a sugar in the 20's, and worry about the order later!

[morte, LPN, LVN]

no, you had an order.

[raskol]

You spoke to a dcotor and got an order for glucagon. No problem.

However, does your facility have standing orders for hypoglycemia? Giving some orange juice or oral glucose? Or calling 911?

I can understand if you went against standing policy but you got an order, so it shouldn't be a huge issue.

[BreeLPN2RN]

You absolutely did the right thing! What is your DON's problem??? Did she say why you should not have given it?

[classicdame, MSN, EdD]

unconscious is near death. Why risk a life?

Dosen't your facility have a policy on hypoglycemia management? I work in a hospital and we treat if 70 mg/dl or less without MD approval. Someone needs to be sure there is a policy to protect you from stupid people.

[loriangel14, RN]

You had an order. Besides, why would you wait for a pt to be uncomscious before giving it? I have never seen anyone leave hypoglycemia untreated until they were unconscious.Why was she not given some juice or something when she was low but still laughing and talking? A low can still be treated even if they are asymptomatic.

[Ruthfarmer]

In all likelihood you saved a patient's life. I believe you did exactly the right thing in following the doctor's order. I would recommend re-familiarizing yourself with the facility's procedures, protocols, and standing orders for hypoglycemia. I would also recommend a sit down face to face visit with the DON, for complete clarification of her specific objection to your administering the glucagon. The DON owes you an explanation and should be very specific in her clarification.

Please do not be too upset or at all discouraged by being reprimanded. Please know that everyday, good nurses who are caring and work with great integrity are reprimanded for the most ridiculous and nonsensical reasons. Everyday somewhere someone fires a damn good nurse with excellent skills, an impeccable record of excellent care, and nothing but the best interest of patients at heart for NO legitimate reason. Some people are threatened by competence and integrity. They can't tolerate those admirable traits in others. This is happens in other fields besides nursing, but it seems to happen more often than you would imagine in the field of nursing.

[Lannister]

You did the right thing.

You had an order and followed it.

I usually treat under 60...

To add... as a nurse... I was taught to treat both short & long (Juice for short and a sandwich/cheese/milk/crackers etc for long)

Lannister

[KyPinkRN]

You spoke to a dcotor and got an order for glucagon. No problem.

However, does your facility have standing orders for hypoglycemia? Giving some orange juice or oral glucose? Or calling 911?

I can understand if you went against standing policy but you got an order, so it shouldn't be a huge issue.

It doesn't sound like this patient was stable enough to take oral ANYTHING. Glucagon was on hand and to call 911 would have just delay treatment of the low bs. I woulda done the same thing.

[Havin' A Party!, ASN, RN]

Once she became disoriented with a BS of 23, of course, your actions were spot on. They likely gave this resident an opportunity to experience another day.

What's not clear from the factual scenario is if the facility has a standard hypoglycemia policy. If not, it should, especially since we're discussing a geriatric (LTC) population here.

Also, it appears many caregivers were previously on notice that this resident had been unstable in the near-past. Perhaps a critique may be that this situation could've been avoided with more proactive care... eg, a pharmacological review with accompanying orders, and a nursing monitoring protocol.

[Silverdragon102, BSN]

You had an order from the MD and if I was a DON I think I would be happy that client was OK and not requiring hospital treatment to the alternative which could be more serious. If you have a few clients that are diabetics it may be worth looking at doing some sort of local protocol with the MD to cover something like this so at least you have something in black and white