Can parents give medically fragile kids meds w/o Dr. order in homecare?

[smartnurse1982]

So,i am in homecare and i am having issues with this.

The kids have various illnesses and most have gtubes, trachs, and vents.

One of the MARS has"give Albuterol at parents discretion" with no parameters.

the supervisor said that we can only give it if the parents think they need it.

I told her that order takes away our ability to use our judgement.

She says the order is fine as written.

This other case of mine,the MOM does not want the child's trach suctioned at all,even after the kids gets Xopenex treatments. This kid is vented also.

One night i watched this kid cough for 3 minutes and sats decreased to 84.

The last parent on this list draws up the meds,places labels on them,and then expects us to give it. i do it but grit my teeth every time.

I don;t really want to mention the Mom that removed all O2 from the home.

This last one concerns school nursing.

The regular school nurse gives out cough drops with no Dr. order.

Do need an order for that since its considered a med?

[smartnurse1982]

Lol, I qualify as my parents child too and I'm almost double 24...

Yes,but i guess i am seeing this from a different angle.

I do not want to commit a 2nd med error because the parent omitted telling me about a med that they gave.

It should be moved to the Private Duty Forum.

How do i get a mod to do that?

[LadyFree28, BSN, LPN, RN]

Yes,but i guess i am seeing this from a different angle.

I do not want to commit a 2nd med error because the parent omitted telling me about a med that they gave.

It should be moved to the Private Duty Forum.

How do i get a mod to do that?

Then isn't there a way for the parents to give you report?

Open the communication channels.

ETA: moving forward from that incident, it behooved you to speak to the parent about the importance of notifying nursing any additional interventions so that they won't be repeated and cause errors.

[psu_213, BSN, RN]

Then isn't there a way for the parents to give you report?

Open the communication channels.

Yeah, that is what I was thinking. You ask them, "gave you given Sam (Johnny, Mike, etc.) any meds in the last XYZ hours?" If they say "no," then it is on them if a dose is doubled.

[LadyFree28, BSN, LPN, RN]

Yeah, that is what I was thinking. You ask them, "gave you given Sam (Johnny, Mike, etc.) any meds in the last XYZ hours?" If they say "no," then it is on them if a dose is doubled.

Yeah, most of my parents were very upfront in giving info if they gave meds; etc. and if they were not, O didn't hesitate to ask.

I had one case where mom checked ears regularly, ten called the doc and they would give abx treatments; kind of an over reach, but that was something that the mom did *shrugs*...either way, she have me a report, even after the nurse gave me one, I took as additional information that wouldn't slip through the cracks.

[klone, MSN, RN]

Well,yes,my agency says there has to be a reason for prn meds.

Yes,it is different.

We know its a prn med but what for?

i mean,we all know but my agency says they need to know the reasons WHY.

I am not sure how you can't see the difference.

I do see the difference. But not writing the indication in the order does not make it any less a PRN med.

[toomuchbaloney]

A nutritionist may THINK that a patient will aspirate the food or THINK that the blenderized food will clog the tube. That is not adequate and means little to me as a nursing professional. I (and you) utilize evidence based practice recommendations.

[KelRN215, BSN, RN]

Nope.

Nutritionist thinks he might aspirate.

Plus,she thinks it will clog tube.

This is what i have heard from the main nurse on the case.

From what i have read about pushing liquidfied food through a gt,the reason everyone was placed on liquids like Pediasure was because of aspiration. Plus,it is not possible to run liquid food over 4 hrs without spoiling.

Well the Mom has already been doing it based on what you said. Is the tube clogged? Nutritionists don't know much about the mechanics of G-tubes in my experience.

Why would he be MORE at risk for aspiration with liquified food than he would be with PediaSure or Jevity or Nutren or Peptamen? That doesn't make any sense. The reason the patient has a GT in the first place might be because of aspiration but the type of liquid nutrition administered via GT certainly doesn't increase or decrease aspiration risk.

In general, tube feeds should not hang for longer than 4 hours. If a patient is on 12 hr tube feeds of 3 cans of formula, you hang one can at a time and refill the bag every four hours.