What would you do?

We were informed by administration that we would be receiving a 13 year old client who is diabetic and has an insulin pump. I work at a free standing psych facility. We have a NP who comes in once a week for minor medical complaints otherwise all other issues are directed to the psychiatrist on call. None of the nurses have ever seen a pumped let alone worked with one. We have voiced our concerns to both the CEO and DON about not feeling comfortable with taking on this client and her care. She not only will have her medical issues to contend with but also will have some behavioral/mental issues as well. We received some basic training via an online module, but not enough to really feel comfortable. Our support staff has not been and will not be trained on signs and symptoms to report which worries me since they are on the units with the clients most of the night. (It's a locked facility and the nurse's station is off of the units....just to give you an idea of how it's set up.) If we refuse to take the assignment I am sure they will send us home, so what are our options at this point? Last edit by LatinGirl on Mar 17, '11
This client is old enough to know how her pump works. If you are NURSES you should have some basic knowledge of diabetes, and maybe you could post a hypo/hyper list for the ancillary staff to see. I was a school nurse and the 6 yr old who had a pump could dial in his dose for his sliding scale.Best wishes!

I'm having a little difficulty understanding your post. You have a new client with a pump and staff have not been trained properly and you are afraid of getting sent home if refusal of care for the client? The only way to get experience with new technologies in nursing is to gain the experience. I understand that this is fairly new and a bit scary however as a nurse I would do my research on the pump and research signs and symptoms. If you have any questions you can also reach out to your supervisor and peers. The client should not be turned way from the facility just because he/she has a pump. It is the facilities job and the nursing staff job to be prepared for the client. Good luck with this and let us know how it turns out.

Assess, assess, assess You could always check her blood glucose at each meal and at bedtime in order to get a baseline where her blood glucose numbers run, but don't forget to monitor her intake and what she is or isn't eating. Always remember your facilities hypoglycemic protocol and implement if needed.

I would educate myself as much as possible on the particular pump this client has. Go online and see if you can find some sort of owner's manual to print out and have available for reference in case there are problems with the pump or in case you think the client is purposely manipulating the pump to cause self harm. Know how to turn the pump off and when the client first arrives, take a good look at the machine so you can familiarize yourself with the controls.Having worked in a juvenile corrections facility I understand your concerns working with a child with behavioral issues who will have mostly unsupervised access to the insulin pump. I would want to contact the endocrinologist's office and have them fax (all proper consents obtained first, of course) the child's diabetic treatment plan to your facility before the client arrives. Then have your medical director review the plan and write orders to cover high and low blood sugars.I would also look into developing a short handout to give to the unit staff educating them on s/s of hypoglycemia. And, most importantly, be sure the staff knows to call nursing if they think anything is going on with the client's diabetes.

Many hospitals have a diabetes resource nurse...maybe you could look into that? Otherwise, maybe you could have an inservice by someone from another unit that sees many diabetic patients so that you know policy, procedure and correct documentation.

Instead of recoiling and refusing, why not have someone contact the girl's parents (and her doc, with their permission) and find out how things are handled at home or at school. Many people with pumps are fairly self-sufficient and have protocols for dealing with any problems that come up.If you can supply juice if her blood sugar glucose level drops below 70, that should be enough for ordinary circumstances. For a hypoglycemic crisis, you can call 911, just as her parents would at home.A little bit of staff learning can meet these fears and defuse them.

Ask the patient to teach you how the pump works.

I also work in a freestanding psychiatric facility (although we have physicians in-house 24/7 because we're a teaching hospital), and our policy, for adults or kids, is that insulin pumps are considered a "sharp"/safety hazard on the units and must be removed and secured (or taken home) at admission, period. No debate, no exceptions. We put people on frequent fingersticks and SSI, and cover them that way for the duration of their stay. Often, the attending physician will consult with the client's endocrinologist re: what that physician advises for fingerstick frequency and SS range, and order precisely what the endocrinologist (or whomever manages the person's DM on the "outside") recommends. The kids are the most challenging, of course, but the physicians consult with the pediatric endocrinologist (or whomever) on the outside, write the SSI orders, and we carry them out.Our biggest challenge, frankly, is getting the kitchen to cooperate with sending appropriate snacks for these clients. Our kitchen rarely has to do much with special diet orders, and it's hard to get them to take it seriously. I typically work evenings or nights, so it's v. frustrating to have an order (not a new order by any means) that a child is supposed to have an evening snack at X PM of X gms of carbohydrate, and, when snack time rolls around, there's no prepared snack there for the kid, and the kitchen staff are long gone. I've had to improvise a few times, and it was really scary (I complained vigorously to my NM about the situation and things improved after that -- I'm sure that, the next time we have a brittle diabetic kiddo, it will be the same thing again, though).I suggest you raise the question with your management of whether the pump is considered safe on the unit in the first place. I don't know how common a policy ours is in psych settings.

Quote from AwayWeGoMany hospitals have a diabetes resource nurse...maybe you could look into that? Otherwise, maybe you could have an inservice by someone from another unit that sees many diabetic patients so that you know policy, procedure and correct documentation.

If I understand correctly, this is an inpatient psych facility? Our inpatient psych patients (I work in a children's hospital) have everything that is sharp or can be used as a weapon removed from there possession upon admission, no ifs, ands or buts. That's all you need is to have another unruly patient get ahold of that pump. Can the pump be removed and your nursing staff cover her with frequent glucose testing and an insulin sliding scale?

Just remember that having no experience is no excuse if something bad happens to the patient. If you accept an assignment you cannot handle, then you are solely responsible for any outcome.