Will I get into trouble by checking my own blood sugar using hospital device?

[Ncap]

I was at work the other day and I felt unwell. A bit jittery, increased heart rate, anxious... I had some juice but the feeling didn’t go away. I decided to check my own sugar using the unit’s glucometer. Of course I didn’t have a patient number to key in, so I just randomly input some numbers. Now I was asked by my supervisor why I didn’t scan patient’s ID band when checking his/her sugar. What should I say? Will I get into trouble if they find out I am checking my own sugar at work?

[JadedCPN, BSN, RN]

19 minutes ago, MunoRN said:

That was the same view as a place I've worked, which changed drastically after a CMS investigation.

There's a common assumption out there that when a visitor or staff member complains of a health issue, that the best way to reduce liability, both to the hospital and your license, is to not get involved other than tell them they should go the ER if they are concerned.

The problem with that is once a visitor says "I think my blood sugar is low, can you check it?" they have now triggered EMTALA, and hospital is required to provide appropriate evaluation.  While it's certainly appropriate to initiate whatever mechanisms are in place to hand off the visitor requesting medical evaluation to the appropriate staff (ER, House manager, RR nurse, etc) there may be appropriate initial assessments indicated to avoid unecessarily delaying care prior to that, such as a BG check or vitals check.  

My (somewhat limited) understanding with EMTALA is that it is a requirement of Emergency Departments specifically, so it would be appropriate of the floor to tell the visitor that they need to check into the ED where they would then be getting the required checkup according to EMTALA.

[amoLucia]

Uh, for the antique nurse here, what is EMTALA? TY

[JKL33]

31 minutes ago, amoLucia said:

Uh, for the antique nurse here, what is EMTALA? TY

Emergency Medical Treatment and Labor Act

In a verrrry small nutshell: The law that says everyone who approaches a hospital offering emergency services for the purpose of being evaluated will be given a medical screening exam by a qualified provider without regard for ability to pay, and if the screening uncovers a condition requiring emergent treatment, the condition will be stabilized (instead of dumping the patient elsewhere). There are a lot more specifics, of course, but these are the basics.

https://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA

[amoLucia]

TY. Now that I know, I believe that I've seen postings in a past few ERs I've been. Even goes into detail re pregnancies, I believe.

I just HATE when things get so abbreviated so much!

[MunoRN, RN]

1 hour ago, JadedCPN said:

My (somewhat limited) understanding with EMTALA is that it is a requirement of Emergency Departments specifically, so it would be appropriate of the floor to tell the visitor that they need to check into the ED where they would then be getting the required checkup according to EMTALA.

I think that's a common understanding of EMTALA, the name certainly would seem to suggest it only applies to Emergency Departments, and the vast majority of EMTALA covered care occurs with someone coming to the ER and seeking evaluation and treatment.  Patients don't actually have to be in the ER for EMTALA to apply, it covers the entire hospital property, both inside and out, including the public sidewalk on the hospital's side of the street.  It also applies to inpatients who came in through the ER weeks ago, or patients who never came through the ER at all.  EMTALA covers everybody on hospital grounds who requires ongoing acute care, or who seeks medical evaluation.  

When a visitor says to you "I don't feel well, can you check by blood sugar?", they have initiated an EMTALA covered request for evaluation (called a Medical Screening Exam, MSE in EMTALA jargon).  You are absolutely free to refer them to the appropriate staff for further care but you are also responsible for ensuring that occurs safely, if you tell them that they are on their own and they then collapse in the stairwell on the way to the ED because their blood glucose was 20, then that falls on you and the facility for failing to appropriately address their medical complaint, which it could be argued should have at least consisted of a BG check before sending them off on their merry way given that they told you they felt it was concerningly low.  

[JadedCPN, BSN, RN]

1 hour ago, MunoRN said:

I think that's a common understanding of EMTALA, the name certainly would seem to suggest it only applies to Emergency Departments, and the vast majority of EMTALA covered care occurs with someone coming to the ER and seeking evaluation and treatment.  Patients don't actually have to be in the ER for EMTALA to apply, it covers the entire hospital property, both inside and out, including the public sidewalk on the hospital's side of the street.  It also applies to inpatients who came in through the ER weeks ago, or patients who never came through the ER at all.  EMTALA covers everybody on hospital grounds who requires ongoing acute care, or who seeks medical evaluation.  

When a visitor says to you "I don't feel well, can you check by blood sugar?", they have initiated an EMTALA covered request for evaluation (called a Medical Screening Exam, MSE in EMTALA jargon).  You are absolutely free to refer them to the appropriate staff for further care but you are also responsible for ensuring that occurs safely, if you tell them that they are on their own and they then collapse in the stairwell on the way to the ED because their blood glucose was 20, then that falls on you and the facility for failing to appropriately address their medical complaint, which it could be argued should have at least consisted of a BG check before sending them off on their merry way given that they told you they felt it was concerningly low.  

Thanks for the info. With that being said, I'm surprised there isn't required annual training on EMTALA across the hospital. Every place I've worked, it was only required if you worked in the ED and/or floated to the ED.

[MunoRN, RN]

42 minutes ago, JadedCPN said:

Thanks for the info. With that being said, I'm surprised there isn't required annual training on EMTALA across the hospital. Every place I've worked, it was only required if you worked in the ED and/or floated to the ED.

I agree that it gets lightly touched on during annual trainings, even for ED staff, the focus seems to be more on things that are more common even though it's the rare situations that are the most important to go over.  It tends to only get the proper attention after an incident where CMS gets involved.

The main focus for accreditation in terms of ensuring EMTALA compliance outside of the ER always seems to making sure the Code Cart that's designated to respond to a code in the parking lot has a working portable suction on it.  

[amoLucia]

Thinking back to OP's original post - suppose a hypothetical visitor came to the nsg desk with the same S&S and requested that Nurse Ncap might check her BG.

Well, Nurse Ncap does NOT have a pt reference ID# for hypothetical pt. So for her to assist the pt, she would be required to send pt to ER while ensuring pt got there safely. She would NOT be able to do a BG on the unit, since entering a phony ID# is forbidden. I'm guessing this is what is being said here.

And what happens if hypothetical pt refuses because no time, no insurance, no money, didn't want to be a bother, etc, et. and just walks out. Nurse Ncap didn't even get a name. How could this episode be recorded? An incident report? And shouldn't management now become involved because of the POTENTIAL for possible neglected care?

Sorry to be hijacking this post UNINTENTIONALLY. But this is very interesting And should be very informative for all newbies and even the unaware 'oldies' like myself. Perhaps the mods can split out these EMTALA postings to provide this educational info for members.

I'm getting the impression that this is rather important information that really should be provided in better detail than it may currently be being done so now.

OP - sadly, it's a sign of the times in that you weren't just able to check your self out, like we all used to do so regularly in the past. It seems you deliberately tried to bypass the system, so that's prob the NO-NO. But it really shouldn't be a national catastrophe! Hopefully, only a discussion will result. Just humbly follow the great suggestions of other posters here. FWIW, I prob would have checked myself out if I hadn't had to go thru all the ID# hooey.

[Hannahbanana, BSN, MSN]

On 9/14/2020 at 2:29 PM, ruby_jane said:

And there was Tylenol and such available too...

Hell, I'm old enough to remember when there was a big jug of Valium on the shelf in the med room... 

[amoLucia]

Quote

57 minutes ago, Hannahbanana said:

Hell, I'm old enough to remember when there was a big jug of Valium on the shelf in the med room... 

 

You win the Senior COB Award! I remember when we didn't have to count it!

[Hannahbanana, BSN, MSN]

COB?

[amoLucia]

Crusty Old Bat! Meant complimentarily. A well-wizened, seasoned, no-nonsense member. Not necessarily based on chronological age. More experiential. But some folk here are just 'old souls' by nature.

Don't know that I've seen anyone with 50 years experience ... hence the award!