To give or not give insulin

[Twisted Nurse]

I have had several patients who are on Novolog sliding scale at the hospital. Sometimes they have to get certain procedures done like angiograms or stress test or colonoscopy that require them to be NPO overnight. When I check their blood surgars, sometimes their blood sugars are around 170s. Other times it can be above 200s.

I've had several nurses say they don't give the insulin despite the number b/c the pts are NPO. Other nurses say they give the insulin depending on how high the blood sugar is. What are your guys thoughts or advice?

[F.E.R.N., BSN, RN]

Where I work, it is stressed that a nurse cannot legally hold or otherwise adjust any medications, including insulin, unless given specific parameters and instructions in the orders. If staff question giving a med as ordered, they are instructed to contact the prescriber with their concerns and get clarification or new orders.

Some docs feel more strongly about this than others here. However, there was an instance of one threatening to report a nurse to the board for practicing outside their license when they held a BP med without consulting the doc.

[MunoRN, RN]

Where I work, it is stressed that a nurse cannot legally hold or otherwise adjust any medications, including insulin, unless given specific parameters and instructions in the orders. If staff question giving a med as ordered, they are instructed to contact the prescriber with their concerns and get clarification or new orders.

Some docs feel more strongly about this than others here. However, there was an instance of one threatening to report a nurse to the board for practicing outside their license when they held a BP med without consulting the doc.

No BON in any state requires nurses to give a medication against their judgement, actually quite the opposite. As a requirement of your license, all nurses in every state are required to hold a medication that is unsafe to give in their judgement. A nurse should always inform the provider, but if the provider is unable to alleviate the concerns of the nurse and still wants it given then the nurse is still not required to give it, if necessary the physician can give it personally.

[F.E.R.N., BSN, RN]

No BON in any state requires nurses to give a medication against their judgement, actually quite the opposite. As a requirement of your license, all nurses in every state are required to hold a medication that is unsafe to give in their judgement. A nurse should always inform the provider, but if the provider is unable to alleviate the concerns of the nurse and still wants it given then the nurse is still not required to give it, if necessary the physician can give it personally.

I can't speak to every BON and every state, but I agree that we are required to act in what we feel is the patient's best interest, and at some times, that certainly means questioning an order, or seeking a new order to cover a new status. At least in my state, the key is whether or not you consult the provider at the time you make the decision (unless you have orders to hold the medication under certain circumstances, "hold for SBP

The reason I mentioned it, was that my facility did have problems with nurses holding meds without consultation. There were commonly held practices like "on this floor, we only give med X if the BP is Y," or "we don't give insulin to patients when NPO." There were usually good reasons motivating such practices, but no actual orders. Many times the docs didn't even know something was "common practice," and were quite surprised it was being done.

[classicdame, MSN, EdD]

there needs to be specific MD orders for NPO status. People need insulin 24/7, even when NPO, to carry out cell functions. Our cardiologists would freak over post-op BS greater than 180. Evidence shows the higher the BS the higher the risk of infection. Anyway, one of JC Core Measures is to have a.m. BS