Missed fingerstick

I am a new grad nurse and just started working on an acute psychiatric inpatient unit 3 months ago. The patients are not bed bound and are up and about on the unit. I had a patient who has fingersticks TID before meals and is on sliding scale. I was finishing up an admission and realized it was already 11:45 and lunch gets served at 11:30. I went to find my patient but she was already done eating her lunch.

I asked another nurse what I should do regarding her 11:30 fingerstick and the nurse told me to skip that one since the patient knows she's supposed to get fingerstick before lunch and she didn't wait or ask for it. But as the day went on, I am rethinking what I should have done. I just want someone else's opinion and rationale behind what should have been done. I will probably find out if there is some official policy regarding missed FS the next time I'm back at work. TIA!
Sorry - it requires an incident report. What if the BS was 285 and required coverage? At the very least a call to the MD to cover yourself would have been appropriate. And of course you needed to document why the ordered procedure wasn't done.

For me, it would depend on what her numbers had been running. If she hadn't required coverage at lunch for a while, then I'd just monitor for signs of hyperglycemia and not really worry about it. If she was normally requiring insulin with lunch, I'd get it asap, call the doc, and ask how much they want to cover with.

I'm a new grad also, but I have not started my job yet. I'm a bit scared of making mistakes too. However, at least the mistake you made did not harm your patient. For example, if you gave your patient insulin when he/she has low blood sugar, it could kill them! But missing an insulin dose will only raise their blood sugar, and should not cause them severe harm in the long term. Just make sure it's documented! I had to take my diabetic cat to the vet this evening as he was very ill, and the vet told me his blood glucose was 27! I feel bad because of that as he was acting strange for several days and I should not have given him insulin before checking his sugar. Hypoglycemia is a lot more severe than hyperglycemia.

When ever I missed finger sticks, I would take it as soon as I realized it was missed & call the Doc, letting him (or her) know that it was taken after they ate & why. If they want coverage they will tell me how much to give. Then I document it all in the patients chart. I also remind the patient that they are also responsible for thier care & should look for me if it's time for thier stick and I'm not there to do it.

Quote from Gerry1888RN... if you gave your patient insulin when he/she has low blood sugar, it could kill them! But missing an insulin dose will only raise their blood sugar, and should not cause them severe harm in the long term... I should not have given him insulin before checking his sugar. Hypoglycemia is a lot more severe than hyperglycemia.

When this happens where I work we just take the BS when we discover the miss and treat accordingly. We don't usually have to notify the doctor or do any sort of incident report, usually just a note.

I would have done the finger stick at 11:45.. and treated accordingly

Quote from mamamerleeSorry - it requires an incident report. What if the BS was 285 and required coverage? At the very least a call to the MD to cover yourself would have been appropriate. And of course you needed to document why the ordered procedure wasn't done.

Quote from loriangel14When this happens where I work we just take the BS when we discover the miss and treat accordingly. We don't usually have to notify the doctor or do any sort of incident report, usually just a note.

i would take it as soon as I realize I missed it, even though they are eating, or have eaten. and then depending on the results notify the MD. The MD will probaby tell you to leave it alone, or order an insulin stat dosage.Then document. That way you can cover ur a** a missed fingerstick is an incident report. What are you going to say, when you get sited, "the nurse told me to don't worry about it"

Quote from bear_momHow do know how to treat? Sliding scale is based on a pre-meal blood sugar, not a blood sugar taken after eating.Emily

"How do know how to treat? Sliding scale is based on a pre-meal blood sugar, not a blood sugar taken after eating."The OP is talking a 15 minute time lapse. Im pretty sure it would be okay to treat accordingly. Ya know like when you find that BS of 30 in the middle of the night and give OJ. You don't retake the BS 2 minutes after giving, you wait until the OJ has time to start working, and treat accordingly. in 15 minutes you have a BS of 40, 30 minutes BS of 70, 90 minutes BS of 300+ LOL