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?

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.

A crusty old bat nurse (I mean that in the most loving and respectful way) once told me that back in the good old days, before tube feedings were readily available, tube fed patients did get the same food as everyone else. There was a blender in the med room, and the nurse took everything from the dinner tray - even the coffee and dessert! - and dumped it into the blender. Voila! Tube feeds.

When you think about it, the food does the same thing once it's in the stomach, whether it gets there via swallowing and peristalsis, or being pushed, dripped, or pumped in via a tube.

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Specializes in Pedi.
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.

I'm not understanding what the issue is with that either. If it's blended to a consistency that doesn't clog the GT, why is it a problem? The patient is being fed. What Mom's doing may, in fact, give the patient a better variety of Nutrition than the standard formulas that most GT fed patients get.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

When the child is in the parent's home the parent may give OTC medications and supplements as they prefer.

The 24 year old still qualifies as the parent's child, especially if they are developmentally delayed.

Funny that we would be concerned about providing actual real food rather than a canned pharmaceutical product for nutrition through a GT.

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Specializes in Pediatrics, Emergency, Trauma.

Funny that we would be concerned about providing actual real food rather than a canned pharmaceutical product for nutrition through a GT.

The horror!! The horror!

(I'm being totally sarcastic).

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Specializes in Complex pedi to LTC/SA & now a manager.
When the child is in the parent's home the parent may give OTC medications and supplements as they prefer.

The 24 year old still qualifies as the parent's child, especially if they are developmentally delayed.

Funny that we would be concerned about providing actual real food rather than a canned pharmaceutical product for nutrition through a GT.

I currently have 3 pediatric patients on a blended diet via GT. Cincinnati Children's have an evidenced based protocol for the puréed by g-tube diet (PBGT) especially for chronic vomiting, failed fundoplication, intolerance of commercial formula, and/or failure to thrive.

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Specializes in SICU, trauma, neuro.

Based on the stools (frequent to constant foul-smelling liquid stools) and nausea that result from adult ICU pts' tubefeeds, I'm thinking a blended diet would be a lot easier on little tummies. The reason for the tubefeeds is b/c the pts can't take their meals po, right? If they were sick but able to chew and swallow, they would be eating the meals their parents cooked for them, right? Like PP's I don't see any problem w/ that as long as the consistency is thin enough to not clog the G tube.

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I'm not understanding what the issue is with that either. If it's blended to a consistency that doesn't clog the GT, why is it a problem? The patient is being fed. What Mom's doing may, in fact, give the patient a better variety of Nutrition than the standard formulas that most GT fed patients get.

I guess you are right,but she does this in addition to his regular tube feedings.

He has been hospitalized often as he gets pneumonia frequently.

The main nurse on that case thinks he is aspirating from too much feedings,

The 24 yr old has gained a large amount of weight from those foods too.

He is 280 lbs.

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

Well, couldn't they d/c the formula and just feed him the blended "regular" food?

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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.

Albuterol is q 4-6 hours PRN.

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Specializes in Complex pedi to LTC/SA & now a manager.
Albuterol is q 4-6 hours PRN.

"Co-Q-10" is a OTC nutritional/vitamin supplement

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Specializes in Pedi.
"Co-Q-10" is a OTC nutritional/vitamin supplement

I think T-Bird was referring to the statement where the OP said there's a MAR that says "give Albuterol per parents' discretion."

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Specializes in Complex pedi to LTC/SA & now a manager.
I think T-Bird was referring to the statement where the OP said there's a MAR that says "give Albuterol per parents' discretion."

Just based it upon the part of the posts quoted where the OP complained parents were giving OTC vitamins/nutritionals without physician order

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