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

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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?

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

Yeah, I was confused by it at first too then I went back and read the OP and saw where it (I assume) came from.

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Albuterol is q 4-6 hours PRN.

No it is not.

My agency supervisor said if it was supposed to be prn it would say "Give every 4 to 6 hrs as needed for wheeze or cough at parents discretion."

My agency does not allow orders to be written without parameters.

One time i had transcribed an order that read:

"Give ALbuterol every 4 hrs prn"

The order was sent back to me by the nursing supervisor because she said she needs a reason.

I had to call the pulmonologist and rewrite the order as:

"Give albuterol every 4 hrs as needed for cough,wheeze,or congestion."

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

Nope.

Nutritionist thinks he might aspirate.

Plus,she thinks it will clog tube.

This is what i have heard from the main nurse on the case.

From what i have read about pushing liquidfied food through a gt,the reason everyone was placed on liquids like Pediasure was because of aspiration. Plus,it is not possible to run liquid food over 4 hrs without spoiling.

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Specializes in Pediatrics, Emergency, Trauma.
Nope.

Nutritionist thinks he might aspirate.

Plus,she thinks it will clog tube.

This is what i have heard from the main nurse on the case.

From what i have read about pushing liquidfied food through a gt,the reason everyone was placed on liquids like Pediasure was because of aspiration. Plus,it is not possible to run liquid food over 4 hrs without spoiling.

But you can't run Pediasure or any other tube feeding over the 4 hr mark either because risk of growth of bacteria; meaning, if it's a 8 hr feed, per policies I'm familiar with, you only can run 4 hrs of feed only because of the same risk.

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

I find it hard to believe that Pediasure and other formulas are preferable to actual FOOD.

And what you wrote regarding the Albuterol makes no sense. "Give albuterol every 4 hrs as needed for cough,wheeze,or congestion" is no different than "Albuterol q4-6h PRN" except that you also wrote the indication. So yes, Albuterol is a PRN medication.

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Nutritionist thinks he might aspirate.

Plus,she thinks it will clog tube.

This is what i have heard from the main nurse on the case.

From what i have read about pushing liquidfied food through a gt,the reason everyone was placed on liquids like Pediasure was because of aspiration. Plus,it is not possible to run liquid food over 4 hrs without spoiling.

Aspirating pedisasure is just as bad as aspirating home brew. Lungs don't say, "Oh, it's pediasure, that's ok!"

And if it was clogging the g-tube, the g-tube would be clogged. Is the g-tube clogged?

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Specializes in Cardiac.

I would suction at my discretion and explain the reasoning to the parent. O2 in the 80s and a persistent wet cough are probably miserable for the child, not to mention unhealthy.. As for the cough drops, from my experience, if a nurse is giving anything (no matter how small it seems) you need a doctors order. However, if the parents gives them to the child, it's just OTC and no order is needed.. I don't know if that varies by agency or state but that's what I've experienced in GA.

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Specializes in HH, Peds, Rehab, Clinical.

Lol, I qualify as my parents child too and I'm almost double 24...

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Specializes in Emergency, Telemetry, Transplant.
I find it hard to believe that Pediasure and other formulas are preferable to actual FOOD.

I agree. And I also fail to see how Pediasure PT is less of an aspiration risk than pureed food through the tube.

As for the weight of the "child"…let's say this was a 16 year old who did not have a tube, was independent, etc. Say he weighs 280 lbs., yet mom allows him to eat all the fast food he want, and most of his free time consists of sitting on a couch, playing video games, eating potato chips. The parent has to take responsibility in raising their child and protecting his/her health. In both cases (the 24 year old with a GT or the obese 16 year old) the mother is not being responsible in how she raises her child; however, other than education, there is not much the nurse can do.

If you, the OP, does not feel comfortable in this situation, it is on you to find a way out. Let's say something bad happens to one of the kids. Even if all of us were to say "the mom is 100% wrong," it could still fall on you if you chose to stay in the situation and say nothing.

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I find it hard to believe that Pediasure and other formulas are preferable to actual FOOD.

And what you wrote regarding the Albuterol makes no sense. "Give albuterol every 4 hrs as needed for cough,wheeze,or congestion" is no different than "Albuterol q4-6h PRN" except that you also wrote the indication. So yes, Albuterol is a PRN medication.

Well,yes,my agency says there has to be a reason for prn meds.

Yes,it is different.

We know its a prn med but what for?

i mean,we all know but my agency says they need to know the reasons WHY.

I am not sure how you can't see the difference.

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But you can't run Pediasure or any other tube feeding over the 4 hr mark either because risk of growth of bacteria; meaning, if it's a 8 hr feed, per policies I'm familiar with, you only can run 4 hrs of feed only because of the same risk.

I thought with closed systems you could run it over more than 4 hrs like ready made formulas(Jevity comes to mind)

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Specializes in Pediatrics, Emergency, Trauma.
I thought with closed systems you could run it over more than 4 hrs like ready made formulas(Jevity comes to mind)

With closed systems yes, but what you're speaking of is not closed...Pediasure doesn't come closed. :no:, heck, most feeds in PDN are the most bang for the insurances buck, and I have always had to mix feeds and refrigerate; I have never seen a closed system in my 7years of PDN pedi nursing.

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