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 L&D.
I would tell you to **** right off if you told me you were going to interrupt my breastfeeding and bonding to administer a medication to my child in another room. FTR, I fully support the parents right to refuse vit K after being given the risks and benefits.

I can't believe that so many facilities still get away with mother-baby separation purely for staffing convenience. Those of you working in those facilities should be advocating for change in procedure. The benefits are so well documented.

For the record (I'm the OP), we do the baby med in the delivery room. Most of the nurses I work with administer them while the baby is still on Mom's chest. Unless peds is present or there's some real reason the babies don't head to the warmer directly after delivery.

I support parents right to refusal, too, but they aren't allowed to refuse the K in NYS. That's the problem.

Up Vote Up Vote ×
Specializes in Midwifery.
Those of you working in those facilities should be advocating for change in procedure. The benefits are so well documented.

:bowingpur:bowingpur:bowingpur:bowingpurNow ain't that the truth! Refusing to do what is detrimental to newborns and mothers.........thats what I'd be doin'.

Up Vote Up Vote ×
Specializes in Midwifery.
I. That would be nice for some moms but like you said there are many that don't want fully room in. We have been told that its the future hope for our hospital but seriously, it will take a lot of trianing in the ob offices and in tours and what not b/c the majority of our patients do not want to room in and will bring baby to us all the time for smoking or for rest or whichever. Now I'm one to say I do tell a really tired mom if she is feeling super tired and would like rest but is holding off b/c she feels guilty, I have been known to say its ok, don't feel guilty, if you want to take the time to rest for a bit its ok. But most of the time its 70/30, seems 70 percent want baby in nursery and 30 percent want baby with them in room.

I'd be interested to see the rooming in come though.

Places all over the world have had these concerns over the years, it is NO EXCUSE! These kids should be with their mothers. Biohazard...eeeck! The bloody mother should be the only one whose picking the kid up anyway! What about the infection risk to all those kids stuck in newborn nurseries...yucko! We ditched our nursery years ago, and you know what, we coped! And sometimes we have kids who aren't bathed fro 24Hrs +. So what? If that bugs you, wear gloves.................:heartbeat

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

[quote=IndigoCarmine;2864614

I support parents right to refusal, too, but they aren't allowed to refuse the K in NYS. That's the problem.

So my question is what is the backlash to the parents ?? They can't refuse, so the hospital and nurse are held to an assault?? Sounds to me like too much liability for the nurse and hospital, if they do refuse does DCF come in, do the parents need a court order to withhold?? I'm sure this has come up before, there's a lot of granola crunching mom's in NYS , what has happened in the past ????? BTW, I like granola crunchers,I was a hippie in a previous life :smokin:

Up Vote Up Vote ×

How can it be state requirement that a baby get vitamin K when parents have the right to make medical decisions regarding their children, icluding any and all vaccines? To the OP, is there a law on the books because if there's not then you cannot give the vit K without parental consent.

Don't get me wrong I think it's absurd to have a parent refuse but I know that I need their consent before I can give it at my facility and if they say no, I chart that it was declined and I have told them the risks of not having it.

I think I have only ever had one patient refuse it.

Up Vote Up Vote ×
How can it be state requirement that a baby get vitamin K when parents have the right to make medical decisions regarding their children, icluding any and all vaccines? To the OP, is there a law on the books because if there's not then you cannot give the vit K without parental consent.

Don't get me wrong I think it's absurd to have a parent refuse but I know that I need their consent before I can give it at my facility and if they say no, I chart that it was declined and I have told them the risks of not having it.

I think I have only ever had one patient refuse it.

Eden, click on the links provided by the OP, it is indeed a law in NY....

Up Vote Up Vote ×
Specializes in L&D.
So my question is what is the backlash to the parents ?? They can't refuse, so the hospital and nurse are held to an assault?? Sounds to me like too much liability for the nurse and hospital, if they do refuse does DCF come in, do the parents need a court order to withhold??

Unbelieveably, this happened again just yesterday. Yucky for everyone involved.

1. Took report on pt at 9cm refusing VitK. Not one but two pediatricians counseled the pt, and extensive notes were written by them and the nurse.

2. Since this was documented up the wahoo, and she was so close to delivering (and c/s bound and really stressed out), and it seemed like a closed case, I chose not to bring up the matter with the pt. again, but *did* inform my charge nurse since she didn't know about it. She, in turn, had to alert nursing supervisor who also hadn't known, and it was SO incredibly busy that she didn't arrive for two hours to discuss it with me; a full hour *after* the c/s, when the pt was in recovery with her baby and her family.

3. My charge nurse instructed me to write an incident report, which I expected. She wanted me to have both peds and the OB provider sign the report. The OB refused to sign it, so I had to document her refusal to sign the refusal, AND

4. the supervisor needed *me* to write yet another note documenting that the parents were informed that under NYS law they would be reported to social work and then SW would have to report them to the ACS and the hospital could not legally clear the baby for discharge without the express consent of children's services.

Talk about suck.

It's really very insane.

And it's about to get a whooooooole lot worse: http://snipurl.com/2ei19

:banghead:

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

Welcome to the People's Republic of New York!

Is there a public outcry over this proposed legislation? I certainly hope so. I can't imagine turning over parental authority and decision-making to CPS based on flawed laws passed by ill-informed legislators.

Up Vote Up Vote ×

Indigo:

Your right, that does suck!

I can't believe the parents were reported just for refusing a damn vaccine, its not like the parents were refusing live saving CPR!

And that article was just creepy . . .gee why don't we just throw out the Constitution and let the govt decide what is best for us "rolls eyes"

This kind of thing is just digusting! I hope NY's lawmakers pull their heads out of their rears and wake up to this tyranny, and put a stop to it! Another thing is, you just know that other states are watching this and who knows how many would try to pass simular laws. (Thus stripping parents their god-given rights to make medical decisions for their kids)

After all drug company lobbyists and state officals know more about what is best for your childern than you and your dr's right?

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

Your right, that does suck!

I can't believe the parents were reported just for refusing a damn vaccine, its not like the parents were refusing live saving CPR! QUOTE]

I don't mean to nitpick, but I want to make one point clear. Vitamin K is not a vaccine. It is a medication administered to newborns to prevent an extremely rare complication of the neonatal period. Refusing vitamin K harms no one, with the possible exception of that individual infant. Hemorrhagic disease of the newborn is not contagious.

In my opinion, it is much like parents who opt to take a "watch and wait approach" to an infant who has been exposed to prolonged rupture of membranes. The baby presents with absolutely no s/s of infection, so the parents and pediatrician together decide to hold off on antibiotics. It is a reasonable decision that can be reversed in a heartbeat if the baby becomes symptommatic. How is that different than the parents who decide against "routine" and likely unnecessary vitamin K administration? Yet the parents who opt to watch and wait with their PROM baby are lauded for being conscientious about wanting to avoid unnecessary antibiotic use, while the parents who opt to watch and wait with vitamin K are reported to CPS and not allowed to take their baby home without State approval.

Sick.

Up Vote Up Vote ×

I agree with every Jolie has written about this situation -- don't touch that vitamin K and inform the administrator, charge nurse, and pediatrician. Document that situation. That's all you can do. That law is absurd and I don't blame those parents for having a letter from a lawyer.

Up Vote Up Vote ×
Specializes in OB.

I am in Indiana and we have a fair number who decline the Vit. K and/or the Erythromycin eye oint. We have a form for them to sign stating that they are aware of the risks, etc., but that they decline anyways.

Hasn't been much of a big deal.

Up Vote Up Vote ×
+ Add a Comment