Alright to have your husband start an IV on your patient?

[Nurse Joey]

I just talked to a friend who told me she had her husband, who is a paramedic, come in and start an IV on her patient. She works in a LTC, the patient needed a transfusion, and no one could get the IV. She claims that everyone on the chain of command ok'ed it. My concern is that he doesn't work for that facility, and he was off duty at the time. God forbid something goes wrong with the IV and the family sues, or the state finds out. When I told her this she acted like I was from Mars and speaking in a foreign tongue. She sees nothing wrong with it, being as it was ok'ed by the doctor who wrote the order, and that he was working under her nursing license. Am I totally crazy?

[Nurse Joey]

My big worry is if something tragic happened, say pt. goes septic, even if the paramedic did everything right. The family, as families sometimes do, would look to assign blame and monetary liability. Since not employed by the facility and not on duty there is not insurance to cover him. I work at LTC's that have paramedics come in and start IV's, but we have contracts with their ambulance companies. The same with services that come in and put in picc's. Actually the LTC in question did have a contract with a local ambulance service, but the nurses don't like them. I just don't see the state approving of someone walking in off the street starting IV's. The LTC hasn't done it's due diligence verifying licensure, their policies and procedures, hippa policy, and infection control. I think the risk is low, but the liability is huge.

[TampaTech]

Its not that big of a deal. I dont know why people make it such. We have medics in the ER's of our hospital chain for tech work and to start IV's because half of the time they are much better then nurses anyways (esp in LTC) I should know this because my brother is a paramedic and is AMAZING at IV's. So here is a little but of advice. Not everything is terrible when someone does it. Everything was given the green light by EVERYONE even the doctor. So I would stop worrying that someone is going to bust a gut or have an annurysim because someone off duty came in and started an IV. The worst that can happen in a real life situation is it gets occluded. Yes, it could get infected, their arm might fall off because of the infection, they could turn septic, and the infection could travle to their brain and they die of a cardiac arrest. But really how many times have you seen that from an IV?

[Freedom42]

I just talked to a friend who told me she had her husband, who is a paramedic, come in and start an IV on her patient. She works in a LTC, the patient needed a transfusion, and no one could get the IV. She claims that everyone on the chain of command ok'ed it. My concern is that he doesn't work for that facility, and he was off duty at the time. God forbid something goes wrong with the IV and the family sues, or the state finds out. When I told her this she acted like I was from Mars and speaking in a foreign tongue. She sees nothing wrong with it, being as it was ok'ed by the doctor who wrote the order, and that he was working under her nursing license. Am I totally crazy?

No way. If a doctor told me that it was OK for a non-employee whose credentials had not been screened by the facility to start an IV, I'd tell the doctor to write the order, give it and document it him/herself. I'd ask your friend how she would explain having a non-employee do the work if her patient had developed a problem. What would she tell the patient, the patient's family, and the insurance carrier who refuses to provide coverage? (By the way, I have a pretty good idea of what her employer would say: That's an absolute deviation from our policy, and that nurse did that independently. Because I'm quite sure her employer didn't document anywhere that said employer authorized a non-employee to waltz in and start the IV.)

No one "works under" another nurse's license, by the way. That's a common misconception. As a nurse you may delegate specific tasks, and you are responsible for ensuring that those tasks are carried out appropriately. But the only one licensed to work by the nurse's license is the nurse, no one else.

[Katie5]

Sometimes we create more to situations than there really are

1. Was the husband a certified and practising RN?

2. Was the patient a hard stick and did he get the IV going?

3. Was there proper authorization and documentation of this procedure from top to bottom?

4. Was the patient's family made aware of the situation?

5. There was no harm or adverse effect to the patient.

If the answers to these questions is "Yes", then rest assured. Otherwise which, there would be heck to pay.

But barring that, how's the patient doing?:)

[Nurse Joey]

"Its not that big of a deal. I dont know why people make it such. We have medics in the ER's of our hospital chain for tech work and to start IV's because half of the time they are much better then nurses anyways (esp in LTC) I should know this because my brother is a paramedic and is AMAZING at IV's. So here is a little bit of advice. Not everything is terrible when someone does it. Everything was given the green light by EVERYONE even the doctor. So I would stop worrying that someone is going to bust a gut or have an annurysim because someone off duty came in and started an IV. The worst that can happen in a real life situation is it gets occluded. Yes, it could get infected, their arm might fall off because of the infection, they could turn septic, and the infection could travle to their brain and they die of a cardiac arrest. But really how many times have you seen that from an IV?"

I've read a story about two doctors being reprimanded for inducing labor and performing a c-section on a patient who wasn't pregnant. How often does that happen? I have no problem with a paramedic's skill, or a paramedic starting an IV. What blows my mind is letting a non-employee do medical procedure. Good luck with your RN classes. Besides the already stated liability issues, think of the PR issues. "Such and such facility" lets just anyone come in and do procedures, I wouldn't want my family there.

1. No 2.No and yes 3. probably not, especially him signing he started it 4. no 5. hard to tell 6. Not my patient

[RNKPCE]

The title of this post creates controversy. If the husband is a real estate agent or mail carrier the answer to this question would be an obvious "No" The poster may not have realized this when it was posted but it changes how people feel before they even read the post. It should have been titled " Is in okay to let a paramedic who isn't an employee of a LTC facility start an IV on a patient"

Then my answer would be " It depends"

[wooh, BSN, RN]

I was working in an ER once, where the P&P said that nurses couldn't start an IJ IV, but the doc on knew that the nurse was a better stick than he was, knew she had a better chance of getting it, so she did the stick, and they charted that he did it.

Sometimes you do what you have to do.

[morte, LPN, LVN]

i would think the logical thing to do would be to send the patient out......

[Freedom42]

I was working in an ER once, where the P&P said that nurses couldn't start an IJ IV, but the doc on knew that the nurse was a better stick than he was, knew she had a better chance of getting it, so she did the stick, and they charted that he did it.

Sometimes you do what you have to do.

So the only alternative was to lie, risk patient safety and put licenses in jeopardy? Why not ask another doctor?

[whodatnurse]

I was working in an ER once, where the P&P said that nurses couldn't start an IJ IV, but the doc on knew that the nurse was a better stick than he was, knew she had a better chance of getting it, so she did the stick, and they charted that he did it.

Sometimes you do what you have to do.

Falsifying your charting??? So once you've crossed that line, where do you then stop?

[carolinapooh, BSN, RN]

The LTC I worked in actually contracted with a pharmacy that had a staff person come and do hard sticks. I'm not sure what this guys educational background was.

What I really remember was that he was pretty cute and everyone got excited when he would show up. Probably why I don't know what his background was....

I think clinical pharmacists with PharmD's can start IVs - someone correct me if I'm wrong. I know my dad used to have his blood drawn by a clinical pharmacist when his Coumadin levels would get checked monthly.

[carolinapooh, BSN, RN]

I've read a story about two doctors being reprimanded for inducing labor and performing a c-section on a patient who wasn't pregnant. How often does that happen?

Better question: HOW DOES THAT HAPPEN???? :eek::eek: