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?

[whodatnurse]

I also wanted to add...the facility must have its reasons for not wanting nurses to do this particular IV stick. If it was a life-or-death decision made in the moment...then what was done should still be charted as to what really took place. Speaking for myself, I would rather be true to myself if I made such a decision and do that than start getting into any white-lie CYA (or anybody else's) business...

[TwilightRNurse]

If I were an administrator of this facility I wouldn't allow anyone, with any sort of license, to start an IV on a patient no matter what. The patient should have been transferred to the ER to have their IV started or could have brought in an independent company such as those who start PICC lines in LTC.

There's too much liability letting a non-employee start an IV on a patient. Just because a doctor ordered it doesn't mean it's a good idea. Doctors orders do not cover stupidity.

i.e. A recent doctors order read Dilaudid 50mg/Phenergan 25mg IM Q 4 PRN pain. Obviously the doctor meant "Demerol". If the nurse were stupid enough to give Dilaudid 50mg IM would it be ok because the doctor ordered it? Of course not....

[Otessa, BSN, RN]

To the OP, this is risky-wouldn't do it.

otessa

[MC1906]

The first thing to do here is to check the policy. If there is not a policy then it's time to create one. I think its a huge risk management issue ...did anyone check with the attorney for the facility? Seems like there needs to be a way to handle these situations when they arise again. Did the patient & family give consent for it to happen this way? By the time you chase down every piece of information and document everything seems like you could have called the closest fire/paramedic station and ask for someone to come over, as you would if there was an emergency (this would probably fall under non-emergent). There is liability even when those who work for the agency does something and we have an adverse outcome. To me it doesn't matter who approved the action, they can easily say, I was not contacted or misunderstood what was being asked. Your actions = your liability.

Ask management for a training class on starting IVs.

[rentalnurse, RN]

Most LTCs here send pateints out for piddly stuff so why wouldnt they sent someone to the ed to get an iv started.

[klone, MSN, RN]

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"

Right. The fact that it's the person's husband is irrelevant.

[klone, MSN, 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.

Now that I absolutely would not feel comfortable doing.

[klone, MSN, RN]

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

There's a thread about it in the OB forum.

[kanzi monkey]

a paramedic, come in and start an IV on her patient. the patient needed a transfusion, and no one could get the IV. it was ok'ed by the doctor who wrote the order

I think this is all the information you need, mainly that the patient needed a transfusion. Starting a peripheral line and getting the transfusion going by people who are trained and qualified to do so is the way to go. I'm thinking the risk of transferring a potentially unstable patient and delaying a needed transfusion is far greater than having a certified person (regardless of where they work and what clock they're on) start an IV. Common sense isn't COMPLETELY absent in health care these days (though it is lacking at times).

[Finallydidit]

Hummmmmm Mom/Grandma in nursing home, hard stick, Who do I want to start the line? Nurse that starts IV once a month, or a Medic that sticks daily?

Give me the medic!!

[RubyRN,CHPN]

Not sure from OP if this was a snap decision on part of LTC facility to allow this happen but IMO (and I say this from a place of not knowing what the paramedic's practice acts allow him to do) seems like State would frown greatly upon this if nurse's spouse was not bound by some type of contract, insurance (both professional liablitliy if he was freelancing) and a worker's comp, etc. Then the HIPPAA thing. Golly then let's get OASHA involved. Just seems like poor judgement on professional boundaries not thinking through the whole process to mention high risk for vicarious liability if there was some kind of legal issue. Sometimes doing right by the pt. extends beyond saving the moment by being Johnny on the spot to do an IV start. So what would happen if during the IV tx IV became infiltrated and had to be restarted? The paramedic was not available to restart? Seems like a SNF providing transfusion services or infusion services to pt. should have some kind of IV pharmacy with Infusion RN's available to assist and contract with them. IV pharmacies usually provide these services.

[Nurse Joey]

Right. The fact that it's the person's husband is irrelevant.

If I posted is it alright to have a paramedic start an IV, then thats a different question. The only reason the paramedic came in was because it was her husband. Not her husband then it wouldn't happen. That's the root.