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?

[eriksoln, BSN, RN]

If this patient hadn't been eating all day, they knew this was coming! Your DON's just ticked off because you handled things correctly without consulting her first. She doesn't want you as an LPN to think for yourself. Makes her look well, sort of dumb.

Hmmmm.

I hadn't even noticed OP was an LPN. Do you really think it was that though? That the DON resents that she handled it right? I don't know how, with the LPN handling it right, it makes the DON look dumb. To me it says they are training people right, have the right policies in place. It was the "not until they are unconcious" stuff that made me question the DON's level of orientation.

I've never been an LPN so I can't say. Does that really go on though? RNs resenting that an LPN does something right? Those RNs are just weird if they do.

[diane227, LPN, RN]

Your action was appropriate and if the DON does not understand this, then she needs to review the emergency care for patients with hypoglycemia. I would have done the same thing. "Thanks for the feedback,,, I will keep it in mind next time I have someone about to die" would have been my reply to her/ him.

[Forever Sunshine, ASN, RN]

I would have given the glucogon.

Maybe I read past this but the thing that puzzles me about this is why didn't she get juice/crackers when the BS was 50? My cut off line is 70 even though the facility's policy states below 60 is hypoglycemia. If the BS is below 70 I give them OJ and graham crackers right away.

Also definitely look at the patient. I was in the dining room one day and a resident's BS(which I took earlier was in the 70s) I told her to eat very well at dinner). Anyway I found her slumped over in her chair, shaky, lethargic. I could tell even without the glucometer her blood sugar was low. I mixed two packets of sugar in a 4oz carton of milk. Within 5-10 minutes she was starting to perk back up again. Just a little trick next time you have a low number and the resident can swallow.

[morte, LPN, LVN]

thinking on this a bit more, i wonder if this is a reimbursement issue? Maybe they can't charge for the glucagon unless there is documentation that the patient CAN NOT swallow??

[mehitabela]

Hell no you weren't wrong! Way to use that nursing judgment! I am a firm believer of patient first. It's got me in hot water with the DON a couple of times but the physician on my unit always backs me up! I pushed glucagon once when patient WAS already in deep doo doo and not even "mine" ( the nurse went on her lunch break with a casual "his BS is kind of low but he's sleeping comfortably." !!!???) but the MD got in the DONs face and told her in no uncertain terms that if a patient of his was crashing like that he had every confidence that us nurses could make the right call and if he had to he would write a standing order for every gd$&@&$& diabetic on the unit! ( yep, he really did say that)!!

[Orange Tree]

Not to be fresh and I'll probably be flamed, but I'd reprimand you for your bad grammar!

If the resident is able to swallow, we would have given oral glucose. If that hadn't worked or she couldn't swallow, we'd give glucagon. The nurses sometimes forget to include a glucagon order on an insulin dependent diabetic, but that really wouldn't stop any of us from giving it.

Your grammar is a bit crazy, too.

I would have given the glucagon without an order.

[NurseLoveJoy88, ASN, RN]

You did the right thing. I was always taught that for any change in level of consciousness you give glucagon.

I had the same scenario with a resident and my DON instructed me to give glucagon while she called the MD for an order and ofcourse we rec'd one. Can't believe your DON.

[prinsessa]

If the resident is still A+O I will give them orange juice no matter what their BS is. I have seen people lethargic and have a BS in the 50s and other people talking to me with a BS in the 20s. I "got in trouble" once for doing something the DON didn't agree with. I wasn't written up (I wouldn't have signed it anyway) but she wasn't exactly happy with me. I feel like I am capable of using my own nursing judgement. It turned out that a few weeks later they changed facility policy and I was in the right for sending someone to the hospital. I always say that I rather get in trouble or get fired then take the chance of losing my license. Don't expect the DON to have your back if something were to happen.

btw, if the resident doesn't have a standing order for glucagon I will give it and then call the MD later. I have never had a MD get upset for doing so. Sometimes you just don't have the time to wait 30+ mins for the MD to call back. I'm sure the MD would actually be upset if I didn't give the glucagon and waited for him/her to call.

[ObtundedRN, BSN, RN]

Glucagon is really expensive, that's probably why your DON chewed you out, lol.

[locolorenzo22, BSN, RN]

wouldn't be suprised with the cost issue.

Working in the hospital we have a new policy to treat when blood sugar is under 70, and a 20 something reading would have got some Dextrose IV, with some oral glucose if tolerated, and a rapid response code.

Good for you for following your judgement, but next time make sure your diabetics have emergent prn meds ordered for this situation, or find your facility policy Before someone has a issue.

[Mommycakers]

A while back I had a pt. who had similar numbers also confused. He would not take the oral glucose due to confusion. I then went to the standing orders we had for IM glucagon. The patient was still conscious and now combative due to the confusion he had to be held down by several people while I administered the injection. So no they do not have to be unconscious.

[CoffeeRTC, BSN, RN]

Coming from a LTC, I too would have given it. As the only nurse in the middle of the night and dealing with this type of issue the injection was the best option. First off, lets say you wanted to give them something oral...LOL, cause unless you brought juice in or hid some surgar packets...good luck fining it. How about the time issue on hunting these down and sititing there getting them to drink it.