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

ËŔNurse~dujour · Dec 27, 2014

Our system, Epic, automatically generates an order when the bg is taken....but yes. I just throw in a note with it. BG checked d/t patient request.

RNperdiem, RN · Dec 27, 2014

I would get an order too. With residents on the unit at all times, this isn't usually a problem. If it is an emergency, I would check the glucose first, get the required orders later.

For the people who don't get the fuss, a lot of us work in places where the purpose of charting is mostly to justify all we do so we can get reimbursed and keep accreditation. Nurses in places like this are heavily audited in their charting(easy to do with EMR). You had better chart that the restraints were checked Q2 hrs, the falls risk documented every shift, oral care Q4hrs etc. Labs need orders to back them up in many workplaces.

mmc51264, BSN, MSN, RN · Dec 28, 2014

We have a code that we can put into glucometer for emergency checks. All RRTs and codes get glucose checks done. I do them all the time w/o and "order". It is a protocol that if a pt is symptomatic, you have to rule out a hypo (or hyper) glycemic event.

nrsang97, BSN, RN · Dec 28, 2014

I would check without an order. A diabetic patient usually knows if they are hypo or hyper. Usually anyone on steroids is a glucose check.

classicdame, MSN, EdD · Dec 29, 2014

we assume it is part of the nurse's assessment when a change in condition is suspected. After all, the MD would rather you call with a number than a request to get a number (requiring two phone calls). If it is not part of policy, recommend it.

0.adamantite · Dec 30, 2014

Yes, in an emergency. For example newly admitted diabetic states "I need to eat, I was in the ED all day and my blood sugar is low!" (usually in this case the blood glucose is between 200-300 lol) and they don't have orders I will check a blood glucose anyway. With any acute change for example change in mental status I will check a blood glucose and vitals etc before calling the MD even if there isn't an order as 99% of the time they will ask what the blood sugar was.

BirkieGirl · Dec 30, 2014

In pretty much most of the facilities in my area, large and small, blood sugar testing is part of the standing routine orders. MOST of the time...so yes.

cayenne06, MSN, CNM · Jan 1, 2015

When I worked in the hospital, all patients on solu-medrol had their urine tested for glucose with each void. Anything 2+ for glucose or higher got a fingerstick. Standard of care, we entered the orders ourselves. The patient is diabetic- if he was at home, he wouldn't call the doctor and say "should I check my blood sugar?" He checks his blood sugar per his own discretion at home. If a diabetic patient, or in the case of my patients, a diabetic patient's parent requests a blood sugar check, I'd do it.

This doesn't make sense to me. IIRC, you're not going to spill sugar reliably until you're serum glucose is in the 200s, right? It seems backwards to use urine as a screening tool, when your patient could very well have labile sugars with serious highs and lows and no glucosuria.

I could be wrong though, and as always I welcome being schooled! Maybe this makes perfect sense and I'm just missing something. I understand that nobody likes finger pokes, so maybe that is reason enough?

Racer15, BSN, RN · Jan 1, 2015

I work in the ED and regularly have diabetic patients request a blood sugar check. If they are concerned, I will do it without question. They know their bodies and even if they don't seem symptomatic, it gives the peace of mind. I don't need an order though, I can just put one in for a simple FS.

VANurse2010 · Jan 1, 2015

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.

Typically acute and critical care RNs have way more autonomy than SNF nurses, in my experiences (I've done all three). Just an observation.

morte, LPN, LVN · Jan 1, 2015

Typically acute and critical care RNs have way more autonomy than SNF nurses, in my experiences (I've done all three). Just an observation.

i would agree, excepting, perhaps night shift. As i said up post, you better have the numbers when you wake a doc up at 3 am!

KelRN215, BSN, RN · Jan 1, 2015

This doesn't make sense to me. IIRC, you're not going to spill sugar reliably until you're serum glucose is in the 200s, right? It seems backwards to use urine as a screening tool, when your patient could very well have labile sugars with serious highs and lows and no glucosuria.
I could be wrong though, and as always I welcome being schooled! Maybe this makes perfect sense and I'm just missing something. I understand that nobody likes finger pokes, so maybe that is reason enough?

I'm not talking about diabetic patients. I'm talking about kids who were temporarily on high dose methylprednisolone. They wouldn't be treating for a blood glucose of 150 mg/dL d/t steroids and we don't like to go around unnecessarily stabbing children with needles. Research doesn't show that it's necessary to regularly monitor blood glucose levels in patients receiving pulse methylprednisolone who are not diabetic anyway though. Monitoring their urine glucose is a less invasive way of checking for adverse reactions to the medication. Is it even necessary? Maybe not, but it was the protocol at this particular hospital along with hemoccult testing all stool. It's also done for babies with infantile spasms who are on corticotropin (ACTH) therapy. Their parents are instructed to check their urine for glucose daily at home during the 30 day course but no serum glucose monitoring is done unless the urine is positive.