Vitamin K administration legal/ethical nightmare!

Specialties Ob/Gyn

Published

Picture this: your pt shows up with a birthing plan that includes "no vaccines for baby, including Vitamin K" but you know that VitK is a state requirement. Period. Aside from it being hospital policy to administer it to every baby born, it is a state policy. You could actually leave yourself open to losing your license if you *didn't* give it. You are breaking the law by *not* giving it.

(nice, right?)

This policy and it's legal ramifications are on file in the nursing admin office (you know this because you called them ASAP!). As much as it stinks to get off on the wrong foot with your pt right off the bat, you inform the pt of the policy and the position you are in.

The family then whips out a letter supposedly written by a lawyer stating that they will sue if their baby gets Vitamin K.

(nice, right? I love it when patients show up to the hospital so incredibly prepared.)

NOW WHAT??

(tell me what you'd do and I'll tell you what happened :banghead:)

Specializes in Nurse Manager, Labor and Delivery.

Oh, I do agree with you. I am truly fascinated that people take the time and research stuff. However, I am interested in HOW they came to their decisions. Because Oprah said so isn't a real answer for me. Some people merely pick a path because they read it on the internet and it sounded good, and have no idea of what it really is they are asking for. More power to people who do their homework. ( I do it myself).

Up Vote Up Vote ×
Specializes in Nurse Manager, Labor and Delivery.

I wanted to add this..but I got cut off and couldn't go back...ack!!! I am all for supporting a parent and their wishes. I don't give any medication without consent ( vit k, hep b, and erythromycin oint). I guess I am disheartened when people come at you with threats of lawsuits right from the get go (as in the original post stated).

Up Vote Up Vote ×
Specializes in Midwifery.

Completely agree with you, but I guess I can understand why they do come in waving lawyers letters around (and I of course come from a very different practice setting where litigation isn't as big of a issue). If people are saying "this is state policy, you have no say" well I'd darn well get myself a letter too!!! We need to practice in partnership with women, and encourage them to take responsibility; and that means letting go of the thought that we always know best! And of course we have a duty of care to ensure the info they have is correct and from a reputable source. It just smarts sometimes when it is; and our patients actually teach us something!!!

Up Vote Up Vote ×

I agree with Jolie's post . . . parents have the right to opt out of Vit K and other things without the nurse being legally liable.

I too am curious about the state where you reside.

steph

Up Vote Up Vote ×
Specializes in Gyn Onc, OB, L&D, HH/Hospice/Palliative.

I just don't see any legal ( nevermind ) ethical dilemma/nightmare, they don't want it, fine, they have the right to refuse, I would be having the nightmares if I did give it against their consent

Up Vote Up Vote ×
Specializes in Midwifery.
I just don't see any legal ( nevermind ) ethical dilemma/nightmare, they don't want it, fine, they have the right to refuse, I would be having the nightmares if I did give it against their consent

ME TOO! Big nightmares....................

Up Vote Up Vote ×
Specializes in OBGYN, Neonatal.

Just an aside here.......does anyone else find that the "birth plan" usually goes to hell in a hand basket.....and everything they didn't want (C/S, epidural, pain meds, etc) happens??????

Yes yes yes and yes!!!!!!!! I've only been in the field for about 6 months now but everyone I work with says if a pt. comes in with a birth plan it seems to always end up in C/S. I have a friend who is getting ready to deliver in a few weeks now and she was asking me some questions as she prepared her birth plan. I did not have the heart to tell her that sometimes things don't go as planned so hopefully everything will be the way she wants it. She isn't planning on anything out of the ordinary, just little things like making sure dad is with baby from the delivery on and for the first bath, which we do anyway if dad wants to so thats cool.

Anyway yes I've heard birth plans = c/s quite often. Strange!

Up Vote Up Vote ×
Specializes in OBGYN, Neonatal.

I work in the state of VA and I've never seen a consent for Vit. K. We have the consent for Hep and we have to see it before we give the vax but never have I seen any consent for Vit. K or ointment. I've never had anyone yet tell me no but I'm sure it will happen!

Up Vote Up Vote ×
Yes yes yes and yes!!!!!!!! I've only been in the field for about 6 months now but everyone I work with says if a pt. comes in with a birth plan it seems to always end up in C/S. I have a friend who is getting ready to deliver in a few weeks now and she was asking me some questions as she prepared her birth plan. I did not have the heart to tell her that sometimes things don't go as planned so hopefully everything will be the way she wants it. She isn't planning on anything out of the ordinary, just little things like making sure dad is with baby from the delivery on and for the first bath, which we do anyway if dad wants to so thats cool.

Anyway yes I've heard birth plans = c/s quite often. Strange!

Treating normal labors as though they were complicated can become a self-fulfilling prophecy.(Rooks)

Up Vote Up Vote ×
Specializes in L&D.

Thanks so much for all your responses.

I'm in New York State where Vitamin K is mandated, unlike vaccines which can be refused. Seems that the law was based on this study (the link is to an abstract. There's a pdf file with the actual article on site). At the time of the incident, Nursing Admin came to the unit brandishing copies of both the hospital policy and the state law. It's in NY State Public Health codes. Peds did speak to the parents then literally washed her hands of it, refusing to even document that she had discussed the issue with them.

(that's fine. It was documented that she spoke with them elsewhere)

When all was said and done, more than an hour had passed after delivery anyway (and the nursery refused report on the baby, just to add to the circus! Nice.)

Like many who posted, I'm really interested in the "whys" of birth plan choices, too. I'm always glad when parents come in reasonably prepared and they have ideas about how they want their experience to be (as long as they understand that things can and often do change) and I'm glad when they take enough time to really think about what they do and do not want for their babe. Personally, I have mixed feelings about vaccines. I'm certainly grateful I got mine, but when I was wee there were far fewer vaccines! Smallpox. DiphTet. MMR. Polio. That's about it. But now? My heart says "too much! Enough, already with the damn vaccine schedule!".

Vitamin K seems like a keeper, though. Low risk. Low cost. Play it safe.

The question as to whether administering the shot would constitute assault did come up amongst the staff. I'm betting that maintaining Public Health Code would override assault charges any day, but geez: who's really going to give a newborn a shot in the presence of his parents who vehemently don't want it? Not me! Assault or not, that's just horrifying!

Up Vote Up Vote ×
Specializes in Maternal - Child Health.

Thanks for posting additional information!

There a couple of things in your post that I don't understand. First of all, you mention that more than an hour had passed since delivery. I question why this is an issue. I'm not aware of any information indicating that vitamin K needs to be given within an hour of birth to be effective. If the parents had relented, would your staff not have given the vitamin K at a later time? It would have been effective regardless of when it was given.

Second, unlike vaccines which protect against easily transmissible diseases, and are therefore a public health issue, I don't understand your reference to maintaining the Public Health Code by administering vitamin K. Lack of vitamin K in a newborn poses no harm to anyone other than the newborn him/herself, so why is it a public health issue at all?

Up Vote Up Vote ×
Thanks for posting additional information!

There a couple of things in your post that I don't understand. First of all, you mention that more than an hour had passed since delivery. I question why this is an issue. I'm not aware of any information indicating that vitamin K needs to be given within an hour of birth to be effective. If the parents had relented, would your staff not have given the vitamin K at a later time? It would have been effective regardless of when it was given.

Second, unlike vaccines which protect against easily transmissible diseases, and are therefore a public health issue, I don't understand your reference to maintaining the Public Health Code by administering vitamin K. Lack of vitamin K in a newborn poses no harm to anyone other than the newborn him/herself, so why is it a public health issue at all?

follow the links that she/he provided.....it is mandated to be given withing the first hour of life.....apparently new york is the 6 th state to mandate, didnt finish reading to see if they mentioned the other five.....i wonder if the technical answer here, is that the hospital would involve ss, the child would become a ward of the state?

Up Vote Up Vote ×
+ Add a Comment