s-q insulin question - please help

colleennurse, ASN, RN · Dec 7, 2006

If you feel more comfortable having a 2nd nurse check the insulin, you could still ask someone else to double check even if they do away with the policy. There have been many things that do not require a 2nd nurse to check, but I ask anyway.

talaxandra · Dec 8, 2006

We have a Single Checking Administration of Medication (SCAM - I'm the only one who thinks that's funny!) policy. Staff must be approved by the NUM, have been practicing for over a year, be familiar with medications commonly prescribed in the unit, be generally competent and skilled, pass an initial and annual competency, and keep a log bok demonstrating safe practice in medication administration.

Any medication can be single-checked (the only exception is blood products, which must be double checked by Federal law), provided the practitioner is confident in her/his ability. In practice, on my ward, that means that we pretty much all hang heparin infusions and give sub-cut insulin, some of us make up insulin or lignocaine infusions, and none of us make up cardiac infusions (because we give them so rarely).

The initial test and annual competency are created by the senior staff (NUM, ACNs, CNSs and the Clinical Support and Development nurse), and are ward-specific. So on our test there are a lot of questions on mixing insulin, trouble-shooting (eg patient with type 1 diabetes has a low BSL, is due X units of this and Y units of that... and what if they were type 2, insulin-requiring? etc)

One of the key points stressed in the whole SCAM concept is that any nurse should feel completely comfortable asking for a double check or advice with any drug at any time. In fact, staff that the NUM doesn't think will ask for help are less likely to be approved.

Hope this helps :)

Tweety, BSN, RN · Dec 8, 2006

Our system is a joke. We walk up to each other and say "how many units in this syringe?"

Yesterday I asked a nurse, "how do I know that's what you're suppose to give? Yeah I agree there's ten units, but what am I agreeing too?" I made her show me the med sheet, the accucheck and the bottle. She was furious. But if you're going to double check, then do it right, what's the point of walking up to someone and asking them how many units are in a syringe? So the nurse overdoses the patient and has a bad outcome. The investigators ask "did you follow policy and double check?" "Yes, I double checked with Tweety"....probably a far fetched risk, but cutting corners and letting our guard down is how errors occur isn't it?

Of all the multitude of drugs we draw up and give on a daily basis, I'm not sure having a double check on insulin really saves lives. But I don't have any evidence.

Trauma Columnist · Dec 8, 2006

At my hospital, we had Pyxis, so you had to have someone come into the itty bitty med room with you, pull the insulin out of the fridge, insert the needle, draw up your insulin and while the needle was still in the vial, ask for second RN verification and then go on. Also, our double check meds were IV dig, insulin, heparin and tPA, and pedi-IV drips.

pattchez · Dec 8, 2006

Thanks for your advice and suggestions. Nurses at my hospital don't always do the "double check" the right way too. I keep thing if we did the "5 medication rights" with all our meds, including insulin, then there should not be a need for a mandated second check. If a nurse would like to double check I think that is fine -- and it is something I have done at times. I am trying to find policy or references that will support this idea. If there is an agency or place I could check for information for policies or best practice articles, I would really appreciate your help, Thanks. Pattchez

gitterbug · Dec 9, 2006

Hey Tweety,

I agree, do it right or don't waste time on a "second check". It only takes a few minutes longer to to a check correctly. Hope you have a happy holiday season.

SuesquatchRN, BSN, RN · Dec 9, 2006

We never checked insulin. Drew it, gave it.

jmgrn65, RN · Dec 9, 2006

we havent' done the 2nd check in years, it was done like tweety said so it really didn't make any sense.

RNsRWe, ASN, RN · Dec 9, 2006

I thought the second check thing was just for us students while in school! There are only three times that a second "check" or second signature actually, is needed: blood product administration (law, not hospital policy), placing a new vial in a PCA pump, and to witness a wasting of a narcotic when it's being signed out. That's it. Otherwise, we draw it up, adminster it. Frankly, if they're going to require double-checks for insulin, why not everything? You could also draw up Dilaudid incorrectly, or unwrap the wrong pill. Why stop at insulin?

**canoehead, BSN, RN** · Dec 9, 2006

Difficult to have a second RN check when there is only one RN on the unit. As students we always double checked insulin and anticoagulants, but as an RN there are much more dangerous drugs I give and titrate without a check. Unless someone has a history of errors, or feels unsure, I think it is overkill.

nurse grace RN, BSN · Nov 5, 2007

We draw up our insulins and give them---we only give sq on our floor- But we must see the result in the computer for the BS --we don't read off of paper or take someones word for it---there have been errors in transcribing.

We witness for narcotics when we are giving a lesser amount than what the PYXIS is dispensing.

We do not open pill packages until we are at the bedside---if the patient has a question or wants to refuse.. we have the packaging available--of course an unopen med can be returned.

Our high alert drips are heparin, digoxin, calcium, insulin,postassium. NACL---high concentration-----we only hang heparin on my floor--we are plain med/surg---no tele etc.

We all feel comfortable asking one another about meds or even calling the pharmacy if we have questions... And why not? Our patients deseve our diligence in providing their medication in a safe manner.:balloons: