Can parents give medically fragile kids meds w/o Dr. order in homecare?

[smartnurse1982]

So,i am in homecare and i am having issues with this.

The kids have various illnesses and most have gtubes, trachs, and vents.

One of the MARS has"give Albuterol at parents discretion" with no parameters.

the supervisor said that we can only give it if the parents think they need it.

I told her that order takes away our ability to use our judgement.

She says the order is fine as written.

This other case of mine,the MOM does not want the child's trach suctioned at all,even after the kids gets Xopenex treatments. This kid is vented also.

One night i watched this kid cough for 3 minutes and sats decreased to 84.

The last parent on this list draws up the meds,places labels on them,and then expects us to give it. i do it but grit my teeth every time.

I don;t really want to mention the Mom that removed all O2 from the home.

This last one concerns school nursing.

The regular school nurse gives out cough drops with no Dr. order.

Do need an order for that since its considered a med?

[Alex Egan, LPN, EMT-B]

Parents CAN give meds without an order. They are exercising their authority to make decisions for the child. Just like an adult home care client who was AAOx3 could choose to take an OTC med. You as the nurse are obligated to follow physicians orders.

As far as the suctioning, are you hearing secretions. A cough doesn't necessary mean the client needs suction. If there are secretions that the client cannot cough out on their own, especially associated with desat then suctioning would be given, and I would take the flack from the parent.

As far as the cough drops. They are most likely just menthol drops, most cough drops are, that's candy not medication.

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings

[smartnurse1982]

Sure,but i am in Pdn and unless these parents do not want nursing,then they should let us nurses handle meds.

Otherwise, i am not sure why the Goverment would give them nursing in the first place.

The jury is still out on the cough drops,because my thinking is "what if a kid is allergic to menthol or some other ingrediant in the cough drop?

Speaking of that,when i worked in Ltc we had a nurse who was written up for giving cough drops without a Dr. order.

I was taught you need an order for anything no matter how small.

Plus,i do not see anything about cough drops in the Policy manual for the district.

[smartnurse1982]

As far as suctioning,i am pretty sure she needs it,esp after a neb tx.

Maybe the state should take away nursing if she is going to tell us how to do our job.

As far as the mom who thinks her kid does not need O2,she has no right to take them out the home because its a prn order.

I believe she stored the o2 in her shed.

[JustBeachyNurse, LPN]

As far as suctioning,i am pretty sure she needs it,esp after a neb tx.

Maybe the state should take away nursing if she is going to tell us how to do our job.

.

As far as the mom who thinks her kid does not need O2,she has no right to take them out the home because its a prn order.

I believe she stored the o2 in her shed.

Then you call child protective services for medical neglect as you are a mandated reporter. Document your parental education regarding risks and notification of supervisor and attending physician. Document lack of O2 presence in home despite physician order. Notify MD & DME company

[JustBeachyNurse, LPN]

Most school nurses work under standing orders. Some school physicians permit pectin only cough drops as menthol is considered a drug. Others do not, not because of allergy risk but because of choking hazard.

[Alex Egan, LPN, EMT-B]

Firstly no parent wants nursing coverage. They need it but generally would LOVE to be without it. I feel as though you are coming at the situation that the family will be grateful to have nurses. In some ways they are but mostly this is not the case.

As to suctioning I'm not there I can't so yes or no to what the patent needs. However I will again say suctioning is not mandatory after a neb, or for coughing. Suctioning is a procedure and has benefits and risks. You are most likely experiencing a backlash from the parent. One time a nurse suctioned to frequently or to deep and it caused a problem, and then the parent says no suction. Is it right no... But unless it is causing harm, all you can do is educate and follow your own judgement on following the instruction.

School nursing is not long term care. Trying to hold them to the standards of a nursing home will be extremely frustrating for you. In LTC you need orders for EVERYTHING. Should each child in school have an order for a regular diet, activity as tolerated, and routine nail care? Ask yourself would you be upset if the nurse was handing out peppermints? Menthol/pectin cough drops are essentially the same thing. One happens to be in the candy isle one is in the supplement isle. Of course that is just my opinion... If it's a violation of district policy, the question I would ask you is "is that the hill you want to die on" meaning is the fight to stop it worth the effort and damage you would to to yourself?

Oxygen should be available. I agree. You should speak with your clinical manager.

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings

[T-Bird78]

I'd think the parents could administer PRN meds to medically fragile children just as they could healthy children. Who administers meds to these kids when there's no nurse in the residence--the parents. There's a 3-year-old in my state who suffered a TBI when a tree limb fell on his head. His mom had 7-day-a-week home healthcare but now it's cut down to 2 days a week, so mom's having to give the meds. Mom knows how to pull the meds, administer, for scheduled and PRN meds. Yes, the O2 situation needs to be addressed RIGHT NOW because O2 is a med!!

[caliotter3]

Any time the exercising of parental authority exceeds my perception of how I can provide safe nursing care, I would leave the case. Once the agency has formally condoned the actions, then it is time to go.

[smartnurse1982]

I'd think the parents could administer PRN meds to medically fragile children just as they could healthy children. Who administers meds to these kids when there's no nurse in the residence--the parents. There's a 3-year-old in my state who suffered a TBI when a tree limb fell on his head. His mom had 7-day-a-week home healthcare but now it's cut down to 2 days a week, so mom's having to give the meds. Mom knows how to pull the meds, administer, for scheduled and PRN meds. Yes, the O2 situation needs to be addressed RIGHT NOW because O2 is a med!!

Yes,except this is not Prn meds prescribed to the pt.

These are meds that the parent thinks the child should have.

One of the parents administers COq 10 w/0 an order.

Its just something mom thinks the kid should have but the Dr. does not.

[realnursealso/LPN, LPN]

Hi, I have tons of experience with Peds home care. FYI, mom or dad don't need an order to give their child medication. They don't need to sign for meds. It is their child and it is their home you are working in. As a nurse in home care, yes, I had to follow the med page, and only give duly ordered meds, the parent on the other hand can give OTC meds without your approval. Sounds like you are trying to fit LTC regs into home care, it won't work. As far as the suctioning and o2 goes, you need to speak to your supervisor.

[JustBeachyNurse, LPN]

Yes,except this is not Prn meds prescribed to the pt.

These are meds that the parent thinks the child should have.

One of the parents administers COq 10 w/0 an order.

Its just something mom thinks the kid should have but the Dr. does not.

As long as the parents are not asking you to give the non prescribed OTC it's not an issue. ( unless of course there is an obvious contraindication such as a jaundiced child on the wait list for a liver transplant and parent wants to give 1g acetaminophen....even then you document, notify MD & your clinical supervisor). While nurses need orders to admin OTC drugs parents do not.