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

Nurses Safety

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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?

If the doctor does not want to write an order for something the parents insist on giving, then document, document, document. If you do not agree with what they are doing or are too uncomfortable with the situation, find another case. Only you know what you are able to accept, and what constitutes reason to leave, for You.

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Specializes in ICU.

I think you have to look at it this way, I as my child's parent administer prescription meds and OTC all of the time. I don't need a doctor's permission to give my child his medications. If he has an antibiotic I administer it, if he has a headache it is my decision when to give him Tylenol. You job as the nurse is different than my role as his parent. You have to have an order to administer meds to my child. Not just anyone can give him meds. You need an order for that Tylenol, I on the other hand do not. That is a liability issue, period. As far as the school goes, I sign a paper at the beginning of the year stating the school nurse can give my child OTC meds, including cough drops. I trust that since she has earned her degree she knows when to administer and how much. Again, has to do with liability. To me a cough drop is not a big deal. If someone's child has an allergy they should notify the school anyway and there should be communication with that nurse so it shouldn't be an issue.

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Specializes in family practice and school nursing.

In NYS a doctor's order is required to give out cough drops to students. Parents , however, can come by the school and administer any meds they want to their kids.

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Specializes in SICU, trauma, neuro.
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.

Co q 10 is OTC, no? So the parent doesn't need an order. Parents give OTC meds all the time at their own discretion. I can understand YOU choosing not to administer it if there's no order, b/c you're the nurse and not the parent. If you want to cover yourself, just tell the mom that you won't give anything w/o a provider order, but will give her space to administer it herself.

Parents don't abdicate their parental rights when they receive nursing services.

Agree with the PP who advised reporting the O2 situation, since that can be a life-or-death safety issue. Likewise if you found out that the parent was administering Percocet that they ordered online to keep their child mellow, I would report that as it's illegal and a very different situation than giving an OTC med.

As for the school issue, the school nurse probably had parental permission to give cough drops. I'm not a LSN but a mom; when I've registered the 3 of my kids who are in school, I've filled out a health form for the school nurse where I've listed meds that I'm giving permission to be administered during school hours.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Parents don't abdicate their parental rights when they receive nursing services.

This, a million times

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Specializes in HH, Peds, Rehab, Clinical.

So what's stopping you from calling social services on these families? If you really feel that they are potentially causing harm to their child, it's your DUTY as a mandatory provider to be an advocate for these children. In the meantime, document, document, document. What is Mom's rationale for removing the O2 from the home?

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.

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Specializes in NICU, PICU, PACU.

I would tell her that the O2 has to be in the house for emergency purposes and storing it in a shed is hazard. If she refuses I would write it up and resign or call DCFS.

And parents can give over the counters, it is their child and do not need an order. You can refuse to give meds without an order.

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Specializes in Pedi.
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.

CoQ10 is an OTC med. Parents do NOT need MD orders to administer OTCs to their children just like you don't need an order from your doctor to take Tylenol. That's why these meds are OTC. Do you think the parent of a healthy 10 year old needs an order to give their child Robitussin or Tylenol or a Flintstones vitamin? Obviously no, so I don't see why you would see it as a problem that these parents are giving their child a supplement that's available to them OTC.

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.

Well, in this case I'd say it's your obligation to report her. You are a mandated reporter and it's unsafe if ordered oxygen is not available if the child needs it.

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CoQ10 is an OTC med. Parents do NOT need MD orders to administer OTCs to their children just like you don't need an order from your doctor to take Tylenol. That's why these meds are OTC. Do you think the parent of a healthy 10 year old needs an order to give their child Robitussin or Tylenol or a Flintstones vitamin? Obviously no, so I don't see why you would see it as a problem that these parents are giving their child a supplement that's available to them OTC.

Well, in this case I'd say it's your obligation to report her. You are a mandated reporter and it's unsafe if ordered oxygen is not available if the child needs it.

Yes, normal kids i see no problems with parents giving otc meds to their kids.

The issue for me i guess is with "non normal kids".

I had a med error once where Mom did not tell me that she gave the kid ibuprofen an hr before my shift and i gave it again.

I did not know until i gave her reportat end of shift(she leaves 5 minutes after i arrive)

My old agency did require parents to sign the Mars to avoid confusion.

Point is understood.

i guess is can just document a real life experience i had where mom blends regular food into puree and mixes it with liquids,and she gives it through the gt.

Supervisor said nothing we can do. in this case kid is 24 yrs old.

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In NYS a doctor's order is required to give out cough drops to students. Parents , however, can come by the school and administer any meds they want to their kids.

I believe in Nj it is also.

Their are no standing orders for the cough drops.

In the P an P manual it even says we are not to give meds without a Dr. order.

I have another question for you guys:

Here is what a district nurse told me you never directly give meds to any staff that comes down for pain meds.

She said you point them in the direction of the bottle and let them take them themselves.

In this district we do not have to log in staff unless it is an emergency.

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Specializes in Critical Care.

Supervisor said nothing we can do. in this case kid is 24 yrs old.

Maybe I'm misunderstanding, but that's not a kid.

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Specializes in HH, Peds, Rehab, Clinical.

At 24, I'd no longer consider my client "a kid".

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