Give prn meds because Mom said to give it?

[Blackcat99]

The doctor's orders say things like "Give tylenol if temp 101 or above." Mom tells you to give tylenol when the temp is 100. The doctor's orders say "Give Benadryl prn for itching/rash. Mom tells you to give benadryl if child is needing a lot of trach suctioning. These are just a few examples. So what do you do when Mom is standing there watching you and telling you to do these kind of things right now? Do you chart prn med given per mom's request? Thanks.

[carwin]

Tell Mom that she is able to use her discretion, but you are bound by law to follow the med sheet as ordered. You can appease Mom and call the PCP for and order change.

[Blackcat99]

Thanks Carwin. I wasn't sure what to do about this situation.

[AprilRNurse]

Yep, agree with above poster. Our policy is to educate mom about the orders, and inform her that she is allowed to give, but that we don't chart it on the med sheet. We put it in the nurses notes, and ask mom if it's something she wants us to ask for an order for.

[Kyasi]

Why not ask the Nurse in charge of the case to add 'for increased congestion' to the Benadryl order and 'for temp over 101 and discomfort' to the Tylenol order? Simple fix. She can make the changes and have the MD sign them. We often add, "per parent discretion" to basic prn meds to cover this situation.

The office staff needs the nurses on the field to be the 'voice' for the patient. You are the ones who are out there giving direct care. When we go out to do start of cares, many of the orders are written based on what the parent tells us. We need the field staff to keep us informed when changes are needed. Just let the supervisory nurse know that mom is asking you to give the med for these reasons and an adjustment can be made on the orders. I've never known a doctor who wouldn't add those reasons to these PRN meds. (think about it, do you wait until your own childs temp reaches 101 to give Tylenol? If he/she is cranky and in apparent pain, and his temp is only 100.2, wouldn't you give it?) The mother isn't being unreasonable to want the Tylenol or Benadryl given under these circumstances.

I would say our agency makes order changes daily on our patients. Just yesterday a HHA informed us that a client wears her leg braces whenever she is transferred. We had them on our morning care plan only. We changed the care plan. The orders for use of the braces was already on the 485, so all it took was for us to correct the afternoon and evening care plans. So the fix on some discrepancies is simple. On meds, all it takes is an order change.

Kyasi

[smartnurse1982]

What my agency does is write the prn orders . Under the orders it will say"ask Mom first".

For example,if an order reads: glycerin suppository 5mg give. 1 via rectum prn for no bm in 72 hours

*ask mom first*

Personally I don't like doing it because it takes away our judgement

I had a dad who had new orders from a doctor but didn't want me to see them he kept saying he would fax the orders to the office. Problem was,it was 12am. He told me abput the med changes but I had to see evidence,but would not let me see them. At 6am,he asks me why I didn't give a med I saw no orders for. I told him I needed to see orders,I can't just go by what you say. He told the agency to not send me back.

[ArwenEvenstar]

If the parent wanted me to give a med that I did not have an order for, or wanted me to give it in a way that was not ordered, I would simply say something like "I do not feel comfortable giving this because my orders don't match, but you are free to administer it yourself." Usually the med was something appropriate, but I just would not risk giving without an order. The parents I dealt with had no problem with this. They understood my caution. (But I know some parents would not be and would be annoyed at you!!) If they gave it, I would just document in notes that "Parent gave ______." I'd make sure to touch base with the office to get the order clarified, so I would be able to give it in the future.

I would never give a med, even something benign and OTC like Tylenol or a basic cough syrup without an order. Other nurses would though! I remember several times calling and getting an official order for something that the parents and other nurses had just been giving for days with no order!! And no one documenting giving it, because there was no order. The stuff that went on never ceased to surprise me...

[Blackcat99]

Thanks all for your imput. Yes, I think the doctor would go along with what Mom wants. Therefore, it shouldn't be too difficult to get the prn orders re-worded.

[caliotter3]

No supervisor I have ever had advocates getting into contests with the parent. They tell us to do as the parent wishes and chart accordingly, something like, "Per PCG (primary caregiver) request, administered...... I will chart my assessment of the patient, especially if it contradicts "reason" for giving the PRN med. If it is important enough that you do not want to do it under the circumstances, then an explanation and a request that the parent give the med, and again, documentation, is in order. If this circumvention of your nursing judgement is a frequent and disturbing occurrence, you might want to assess whether or not this is the right case for you.

[Blackcat99]

Thanks caliotter 3. Yes, I have also heard the opinion that we are suppose to do what Mom says to do. I heard that if you don't want to do what Mom says that Mom will call the agency and will tell them to not send you to their home anymore.

[caliotter3]

Yes, this is usually the response. The parents fire you and the agency goes along with their wishes. The agency does not care, they send out the next victim from their long list of nurses who need work, hoping that the next nurse is smart enough to go along with the game plan and keep her/his mouth shut. I have only ever had one Director of Clinical Services who had enough of a backbone to state unequivacally that she would get the doctor involved. All other supervisors have only wanted the field nurses to shut up and not complain. You have to decide how badly you need the job and calculate whether or not you would be given a replacement case or not. After awhile, the agency will stop sending you if they determine you are "high maintenance". This is the part of home health that people don't talk about very much.

[WI_home_RN]

At my peds case, Mom often tells us to give this or that. However, the meds that she asks us to give are listed on the Plan of Care with a very generic PRN order so that us RNs do feel comfortable giving the meds when Mom asks. But we also document, document, document and especially when Mom requests the med, we document that fact as well. Mom also is very lenient at the same time telling us to use our judgment when we feel PRNs are necessary. I have gotten into the habit of asking this Mom's opinion of different PRN meds before I give them but she always just says to me "use your judgment" but I just feel better running it past Mom before I give it if its daytime and she's awake.