RNs to do glucose checks on patients without DM

[sistrmoon]

PCAs have done our fingersticks since I came to this hospital 6 years ago. Now they are saying that if a patient is critically ill(defined as a 1:1 ratio, doesn't apply to our floor) or the patient is having glucose checked without a diabetes diagnosis, the RN has to do the check. We are Onc so we do have people on steroids who get checked and people with enteral feeds get checked as part of the protocol. Any idea why this would be? We were just told it was a new state regulation.

[cassie77775]

We do all of our own glucose checks. Something I guess happened where a nursing assistant didn't report off the check or something to that effect. We don't do many aside

from our newborns.

[SierraBravo]

I'm not licensed by either but I am just as confused as you as to what the NY dept of Education has to do with any of this.

It all seems to have come about after the FDA pointed out that using glucometers for anything other than the "ongoing management of diabetes" is off label, which wouldn't really seem to matter since there is a long list of things we do that are "off-label". Labelled indications don't limit how a device, medication, etc can be used, it limits how it can be marketed, so I really have no idea how limiting glucometer use in critical care and on non-diabetics to only RN's has anything do with the FDA's statement.

In NY, RN's are licensed by the NYS Dept. of Education.

NYS Office of the Professions - State Education Department

[MunoRN, RN]

This seems to be the source of the practice change:

Laboratories that use glucose meters for purposes or in populations beyond the Intended Use in the package insert or device manual are considered to be engaging in

off-label use. The Centers for Medicare and Medicaid Services (CMS) have instructed

us that the laboratory must be informed that in the event of such off-label use, the

glucose meter defaults to high complexity and the laboratory must meet the CLIA

requirements for high complexity testing. In New York State, this means that the testing

would require a New York State clinical laboratory permit in the category of Clinical

Chemistry and only personnel licensed by the New York State Education Department

would be eligible to perform the testing.

http://www.wadsworth.org/labcert/clep/files/Glucose_meters_off_label_use_1_13_14.pdf

Oddly, "only personnel licensed by the New York Education Department" would also include architects. So apparently architects are qualified to to do fingersticks, but CNA's/Techs are not. Actually, CNA's are qualified according this rule but only if the patient has already been diagnosed as a diabetic, which makes even less sense.

[Dranger]

I have to do all my own glucose sticks usually 6-8 times a shift. So what?

[Esme12, ASN, BSN, RN]

When does steroid induced hyperglycemia become steroid induced diabetes?

As long as I remember....Steroid diabetes (also "steroid-induced diabetes") is a medical term referring to prolonged hyperglycemia due to glucocorticoid therapy for another medical condition. It is usually, but not always, a transient condition.

Steroid-Induced Diabetes - Lupus

Hyperglycemia related to high-dose glucocorticoid use

Steroid Induced Diabetes - University of Michigan ...

Steroid-Induced Diabetes Mellitus and Related Risk Factors

Glucocorticoid-induced diabetes and adrenal suppression ...

Few laboratory instruments are as ubiquitous as the humble blood glucose meter. Yet in recent years, they have become essential not only for managing patients with diabetes, but also for improving outcomes for other groups of patients at the point-of-care. Studies connecting hyperglycemia with poor outcomes have led many hospitals to rely on the convenience of these meters for managing care across a spectrum of hospitalized patients.

Regulators, however, including the Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid Services (CMS), have become increasingly concerned about this practice because none of the meters on the market are FDA-cleared for use in critically ill patients, such as in the emergency department or intensive care unit. In fact, manufacturers submit meters intended for hospital use as over-the-counter devices, which means that FDA clears them based on the same standard as the home-use meters found in drug stores.

There have been studies that indicate that the use of glucometers in an acute population lack accuracy and have a wide variance of accuracy dependent on the user and quality control. The joint commission has made recommendations but have not revealed a position paper as they are looking at the data available to further evaluate recommendations for the critically/acutely ill patients.

FDA Moves on Blood Glucose Meters

http://www.fda.gov/medicaldevices/safety/alertsandnotices/publichealthnotifications/ucm176992.htm

[sistrmoon, BSN, RN]

I have to do all my own glucose sticks usually 6-8 times a shift. So what?

My point is that it would be less labor intensive/confusing to just require RNs to do all checks than to require us to research why each patient needs the check and divvy up the checks. Actually my point was wondering why the change came about and thankfully someone actually answered my question rather than just giving me unhelpful attitude. But yes, heaping on more and more tasks, even if they are simple, is not helpful. Yes I am capable of doing total care for 6 patients but I would probably also burn out quickly. I left my old hospital for many reasons, one of which was utter lack of support staff.

[SierraBravo]

My point is that it would be less labor intensive/confusing to just require RNs to do all checks than to require us to research why each patient needs the check and divvy up the checks. Actually my point was wondering why the change came about and thankfully someone actually answered my question rather than just giving me unhelpful attitude. But yes, heaping on more and more tasks, even if they are simple, is not helpful. Yes I am capable of doing total care for 6 patients but I would probably also burn out quickly. I left my old hospital for many reasons, one of which was utter lack of support staff.

I fully appreciate what you are saying about the lack of support staff. My contention is that the techs/aides don't fully appreciate that I can do their job, but they can't do mine.

[wooh, BSN, RN]

I have to do all my own glucose sticks usually 6-8 times a shift. So what?

And your profile says you do ICU. Big difference between adding a task to someone with 2 patients and adding a task to someone with 5-6-7-8+...

[Esme12, ASN, BSN, RN]

My point is that it would be less labor intensive/confusing to just require RNs to do all checks than to require us to research why each patient needs the check and divvy up the checks. Actually my point was wondering why the change came about and thankfully someone actually answered my question rather than just giving me unhelpful attitude. But yes, heaping on more and more tasks, even if they are simple, is not helpful. Yes I am capable of doing total care for 6 patients but I would probably also burn out quickly. I left my old hospital for many reasons, one of which was utter lack of support staff.

Talk to management. From how you describe this facility...it sounds to me like they were trying to not dump on the nurses any more than necessary.

[applewhitern, BSN, RN]

Nurses have always done their own glucose sticks at my current facility. They have never allowed the nursing assistants to do them. Not saying that I like it this way, just stating the way it is.....