Dr orders for HH Nursing

Isabelle49 · Mar 21, 2011

I am new to HH and I know that you need a Dr's order to do anything. My question is a pt today had a VA shunt that from what the nurse who was orienting me said was supposed to have pumped Q2hr. Well she explained that she was told by the pt mother that the shunt was not draining properly and that mother looked up the procedure online and wanted it done a certain way, in other words she told the nurse to pump the shunt a completely different way than how the orders were written, and the nurse was doing it. Now the pt was headed to have a CT scan since she was becoming unresponsive. Since I am new to this agency I told the orienting nurse that I was uncomfortable with this pt and I promptly left the house and called the scheduler and told her the situation. The scheduler then said, well maybe since they are doing the procedure wrong, perhaps that's why the patient is having ICP. Was I right about leaving the home? Any advise?

I think it would have been best if you had called the doctor, while still at the home to explain the situation. If the patient was unresponsive or becoming so, while you were at the home, you would have done best by staying with the patient until transported. Upon entering a patient's home, you have accepted the assignment and by abruptly leaving, that could be seen as abandonment. During the time you were in the home, it would have been best to call your supervisor about the situation. I see from your post that you were orienting with another nurse, and assume she stayed until the situation was under control. What I have posted would definitely be how I would expect any prudent nurse to handle that situation.

MonkeyLPN · Mar 21, 2011

At the time that I left the patient was responsive, so it was not a medical emergency. She had been having ICP, but they could not get anyone to see the patient in the area because she is so complicated, medicaid pt, etc. She had the shunt replaced in Jan and the nurse that was orienting me was telling me that the mother looked up the procedure that she was doing up on the internet. I'm sorry but I do not think that at anytime should a nurse be doing anything that the untrained mother looked up online.

Also I was not being compensated as I had not agreed to take on this case quite yet, so I do not think that abandonment at all applies. I talked with the scheduler and she said that she was glad that I passed on the info and that she would find me another case.

The whole situation made me very uncomfortable. I am not about to do something that would jeopardize my license in anyway as would be the case if I followed this nurse's example. I guess I just learned a little more about HH. I need to ask more questions and see care plans before going into the house. Or I need to find something else to do?

caliotter3 · Mar 22, 2011

While it would have been nice for you to help get this resolved with the doctor, I don't believe you were obligated to take action with the other nurse's patient. She was on duty and had legal responsibility for the patient.

MonkeyLPN · Mar 22, 2011

The thing about getting the orders clarified is exactly what was not being done by any nurses that have been doing this "online" procedure for a few weeks now. That is why I left the home. The mother and nurse were on board doing this with the pt. They did not see any problems with it. That is where my issue starts. That they thought it was appropriate to do research online about shunts and not being the surgeon that placed the shunt in the first place. So how really would they know what they needed to do, how could they make assumptions about the proper way to care for the patient? I felt that I needed to let the scheduler/supervisor know immediately what was going on as I felt the patient was in need of a supervisor visit from the agency.

caliotter3 · Mar 22, 2011

Make sure you make a communication note in writing and keep a copy.