Would you take a patient's blood sugar without an "order"?

LightMyFire · Dec 27, 2014

I would check if the pt asked. If a pt has q4 vitals ordered but requests a BP check would you not do it? I check if requested and call the doc if it's not WNL and request orders to address the BG. If I know the pt is diabetic and no SS is ordered, I catch them or call and request orders.

PatMac10,RN, RN · Dec 27, 2014

It's never been an issue at my facility. NC declared that blood sugar checks via finger sticks was no longer considered a nursing level skill a few years ago. We have policy where we can get a blood glucose via finger stick or pt. Central invasive line (if permissible with the particular device) if there is legitimate cause for concern or when we need a blood sugar to rule out hypoglycemia or hyperglycemia when completing an assessment.

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RedInScrubs, ASN, RN · Dec 27, 2014

I've had patients come to the floor without orders at all but taken their sugar because I needed to know if they were bottomed out and had reasons to suspect they were. I would consider it a nursing discretion intervention, especially if you have reasons to believe it's a priority, i.e. very low.

In the case of the OP, just a request based on it possibly being high is probably not an acute issue, and you should just be able to call the doc and request an order to do it based on x, y, and z without the patient being in a priority situation where they NEED to have it checked.

vintagemother, BSN, CNA, LVN, RN · Dec 27, 2014

I'm in LTC. Yes, after learning from my mistakes, I now consider FSBS a part of vital signs. I noticed that when EMTs came after a call for transfer due to altered LOC and syncope and I noticed they took an FSBS (with 1 instance of hypo and 1 instance of hyper blood sugar) I now consider FSBS as an important tool to ascertain the client's V/S.

I would obtain an order after the fact if my facility reqd it. Thank goodness, our MD is easy for me to communicate with, trusts my clinical judgement and would give me an order for it after the fact, were it needed.

Caffeine_IV · Dec 27, 2014

Yes I would. Usually I'm checking for hypoglycemia when I do a random check. If the patient ask, I will do it.

Tenebrae, BSN, RN · Dec 27, 2014

At the risk of being rude, why should you need permission to take a patients blood sugar it makes very good clinical sense, especially if the patient is diabetic and on a sliding scale insulin.

District nursing i would often take a a blood sugar with a new wound admission. Uncontrolled blood sugars are a mega contributor to poor wound healing

jadelpn, LPN, EMT-B · Dec 27, 2014

In a perfect world, part of the standing orders for diabetic patients, especially those on steroids, should be a sliding scale for coverage with insulin at a higher blood sugar amount than what may be usual for the patient. With a "call MD for FBS over _____" It may be the nurse calling the MD and asking for an order for patients with diabetes and who are on steroids.

If your insulin coverage is ordered for before meals and nightly, then by doing random glucose checks you are probably needing to call MD for a change in the order (and prn as indicated). Because steroids make a blood sugar reading rise, I would think that you would be covering with insulin a great deal.

How Prednisone Affects Blood Sugar | Speaking of Diabetes | The Joslin Blog

firstinfamily, RN · Dec 27, 2014

I found when working LTC we were "not allowed" to get a blood sugar unless there was a MD order. However, if I suspected any hypo or hyper glycemia, I did it before I called the MD. The MDs expected us to use our assessment skills and to give results to them as indicated---however, nursing management was in another ball park. In acute care we are covered by "nursing protocol" and can write our own orders. For someone who was receiving steroids we know the blood sugar is going to run high because of the medication, but if the pt was exhibiting symptoms of hyperglycemia then I would go ahead and get a blood sugar, not just because the pt asked me to, unless he/she was asking because they felt they were having some symptoms----I would ask them "what are you feeling right now?" and go from there. This pt should have routine blood sugar checks already scheduled, so an extra check just done randomly may not reveal any new information. We expect them to run high, the routine ones should show this and adjustments to insulin or hypoglycemic medications be done accordingly. Just remember, when he/she comes off the steroids, the insulin needs to be lowered also!!!

blondy2061h, MSN, RN · Dec 27, 2014

I think some facilities and some states treat this more harshly than others. My state is particularly strict. A fingerstick glucose is considered a lab, and carries the same weight as if you decided to check thyroid levels without an order (emergencies excluded). Our critical care orders state to check glucose q4h x 24 hr kb admission to ICU and begin insulin protocol if 2 bg's >140.

kbrn2002, ADN, RN · Dec 27, 2014

I not only would, I do. But I do work in a SNF so we probably have a little more leeway with doing things at our discretion than a hospital nurse would. I will check a BGL any time a resident requests or if they are symptomatic, and it is policy to check the BGL of any resident with a diabetes dx post fall to rule out hyper or hypoglycemia as a contributing factor. I will also initiate orders to start daily checks on a resident on long-term prednisone if it is missed, our rounding is more than happy to sign off on this and appreciative that it was caught.

erifica · Dec 27, 2014

Taking a blood sugar is nursing judgement. If your patient has signs and symptoms of hypo or hyperglycemia then I would take the blood sugar. I would document the rationale. I would also call the doctor and question why the patient isn't on blood sugar checks. Maybe it was an oversight? I work in a hospital. I also think that you have to consider, if I don't take the blood sugar what could happen? If someone has low blood sugar and you do nothing or high blood sugar and you do nothing? Then it comes down to what is most safe and logical.

ANnot4me · Dec 27, 2014

This is an interesting thread as I would not think twice about taking a CBG in the acute or LTC setting if I felt it was necessary. I would definitely take a CBG before contacting a doctor about any acute change in a patient as blood sugar levels will be one of the first questions asked. Blood sugar levels are affected by many medications and fluctuate for many reasons. It is not always about steroids and diabetics.

Most patients who request a CBG have some knowledge of what it means to them or they would not ask. I would be more fearful of ignoring thier request than to check their blood sugar.