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.
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.)
(tell me what you'd do and I'll tell you what happened
I have lived in several different states. In all those states children are required to have certain vaccinations. (Actually, technically, I don't think vitamin K is a vaccination, it is a medication.) But vaccinations first. All vaccines can be refused by the parent. You cannot lose your license if you do not give it, but the parents have to sign a form that says they declined. The facility keeps the permanent copy and gives the parents a copy.
As to vitamin K. Not a vaccination, it is a 'medication' that helps baby with clotting, as some babies are born without inherent vitamin K and can bleed, including uncontrolled bleeding in the brain. It is easily prevented by a dose of vitamin K at birth. In all states in the US, medications can be refused. Again, get a signature from the parents saying they have been informed of the risks to the infant and are willing to accept those risks. If something happens later, the PARENTS can be sued for not getting the child appropriate medical treatment.
Some women will take extra vitamin K for a few weeks before the birth of the baby. I don't know if that is effective. There is no hard evidence for the practice of giving it in the first hour of birth. Within a few hours is more than enough. There is some debate that all babies are vitamin K deficient, but the biggest danger is the infant without any. The deficiency may not manifest itself for days or even weeks, and affects 1 in 10,000 full term neonates. There isn't a really good cost effective non-invasive way to screen, it is easier to just give the vitamin K to all. It's a vitamin, and in general will not harm those who do not need it.
Sorry, more info than you probably wanted to know, but it is important to know WHY we give the meds we do. It's hard to convince a parent if you don't really know why other than 'they told us to'.
Last edit by Halinja on May 12, '08
: Reason: I keep thinking of more to say
May 12, '08
I remember my OB instructor (CNM) sharing in clinical how traumatized the department was after they lost a baby after the parents refused vit k.
The lesson I took from that was just how important good patient education is in helping parents make good decisions. I am pro vaccination so I really struggled mentally with those parents who did not start the hepatitis vaccination series.
Vit K is a vitamin that is Low costand low risk. I think that there was some information read by the patient on the internet that was written by a yahoo claiming that it could lead to injury. I ran across a reference that basically said for BREAST FED infants there is a 1.8 case per 100,000 increase in bleeding injuries/deaths for infants NOT given vit K vs a 1.5 case/100,000 increase in leukemia for infants given Vit K. The risk of death is greater without the VIT. K. I don't know if this difference achieves statistical significance but I think the sheer numbers would make my mind up.
at http://www.babyreference.com/VitaminKinjectORnot.htm .
Extracting data from available literature reveals that there are 1.5 extra cases of leukemia per 100,000 children due to vitamin K injections, and 1.8 more permanent injuries or deaths per 100,000 due to brain bleeding without injections. Adding the risk of infection or damage from the injections, including a local skin disease called "scleroderma" that is seen rarely with K injections,8 and even adding the possibility of healthy survival from leukemia, the scales remain tipped toward breastfed infants receiving a prophylactic vitamin K supplementation.
This stuff drives me crazy as most people have no idea just how small 2/100,000 is as a number.
To put it in perspective. Mn Had 73,515 live births in 2006
. Chances are there was less than 1 childhood cancer statewide that could be attributed to Vit K.
Last edit by HM2VikingRN on May 12, '08
May 12, '08
I hand it over to the Peds, I'm sure there is one involved somewhere, he/she can discuss it with the pt, if she still refuses, he/she can have her sign a waiver, I wouldn't give it unless she consents, it's not that critical, I'm sure many babies who are home-birthed don't receive it, JMHO :stone
Last edit by GrumpyRN63 on May 12, '08
: Reason: sp