B12 Injections - Teach the Family?

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In our agency, RPN's have to take a special course in order to do an IM injection, e.g., for Vitamin B12.

Last year, I was asked to teach the daughter of an elderly patient to do the injections, and I told the client I wasn't comfortable with doing this. RPN's need special certification...should we be trusting the family to do this, especially when it's only once a month?? (Not frequent enough practise, IMO!)

The CCAC case manager was really ticked off at me over this. The daughter, realizing this was not a simple procedure, finally agreed to let the family MD do it.

What's your opinion on this? There is a form of B12 that can be give subcutaneously, and if the MD had ordered that instead, I wouldn't have had a problem.

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Specializes in Home Health.

What is a RPN? That is my first question. And, if we can teach families to monitor IV's at home, why not give an IM? I agree a SC would be much easier, but I see no reason why someone couldn't be taught to give any IM injection.

This is an interesting question though. I have one pt in HH who was getting avonex IM and another injec (I forget now which it was) SC, the pt mom gave the sc, and refused to learn/give the IM, but this was all so that they could still get a HHA under Medicare, keep that SM need for IM injection out there. Mom told me it was the doctor who told her she shouldn't give thei, only the nurses could. I say Hogwash, but maybe I am wrong. BTW, I wasn't going to rock that boat as pt was already on service for 2 years.

So, what does everyone else do??

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Specializes in MS Home Health.

We always taught people if they could get past the muscle injection for IM. Alot of people cannot do that. I think I would have a hard time doing an IM on myself but SQ would be no problem at all.

renerian

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Our responsibility in home health care is make the patient once again independent. We can also look at this another way. The practice of the art and science of Nursing is based on Theories. One of the most used theories that nursing is based upon is Orem's Theory of Self-Care Defcit. The patient currently has a deficit -- the inability to give the IM injection of B12. By teaching the patient to give the injection we have eliminited the deficit. That was our goal.

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When i worked at an endocrine clinic, we always gave B12 injections SC...and I learned in school to give it IM. MUCH easier for a patient or family to learn SC though.

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I agree. It is much easier for the patient to give a SQ injection versus IM. It will depend on the base of the B12. Is it an oil based injection, which must be given IM or is it water based?

The goal remains the same. Eliminate the self-care deficit the patient current has by instructing him/her to self-admin the B12 injection.

Another aspect to this situation: I hope the patient/caregiver understand that B12 injections are for LIFE, and are not going to be given for a short duration then discontinued.

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In Ontario, we have a protocol for determining when it is safe to delegate a nursing task to someone who is not trained for it. One of the criteria is that the task has to be done often enough for the person to maintain competency at it. This injection was to be given monthly only, so my feeling was that this wasn't frequently enough for the caregiver to maintain competency. And even if the task IS delegated, the nurse still has to supervise, and be responsible for monitoring the patient, so, in effect, I would not have been able to discharge them.

BTW - RPN is the same as LPN.

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Originally posted by Jay-Jay

In Ontario, we have a protocol for determining when it is safe to delegate a nursing task to someone who is not trained for it. One of the criteria is that the task has to be done often enough for the person to maintain competency at it. This injection was to be given monthly only, so my feeling was that this wasn't frequently enough for the caregiver to maintain competency. And even if the task IS delegated, the nurse still has to supervise, and be responsible for monitoring the patient, so, in effect, I would not have been able to discharge them.

BTW - RPN is the same as LPN.

I see your point Jay-Jay, but if the person is going to be on B12 injections for life, that's a different story. And it depends on the comfort/skill level of the person you're teaching too.

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Jay,

I think the protocol you have is excellent, but it is not designed for home care in the U.S. We would be going by Medicare Standards or some other private insurance company and the insurance company would require us to teach and get out.

I have been very scared many times when I have had to leave a patient on his/her own.

With the new payment system for PPS (Medicare) the nurse would be able to stay in longer and supervise the admin of the injection. We would have requested an order from the MD getting the Sub Q injection type versus the IM. Then the teaching goes so much easier and faster.

Jay, from what I have gathered thus far, I would love to have you as one of my nurses. It is not often I find one as dedicated to the patient. It is an honor to meet one.

P.S. I am sorry it has taken me so long to respond. I have been busy with home visits (my nurses are completely full), plus trying and preparing lectures for classes.

Thanks for your reply.

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