Frustration!

[dterra23]

Just need to vent ...

im a private duty nurse for pediatric patients and my current patient is on a feeding pump. I received new orders to start him on a different feeding formula but when I got the orders I did not get a rate for the formula he had been on a trial run for his new formula and for that I did have a set rate. The dietician calls me today and says that with this new formula he's supposed to start they can't give me a set rate because of the thickness of the formula I would have to find the rate myself by changing it until I found a rate where he's able to get his 3 daily pouches of food within 14hrs. I told her I was not able to do this and that I needed a specific rate for the feeding to be able to input the order. She said she would call the company directly and let them know what was going on. I immediately called my supervisor after speaking with the dietician and told her what was going on. My supervisor says I have to input the order but I told her I don't have a rate and I don't feel comfortable doing it. I told her that I have been having trouble with this formula since last week and the supervisor I spoke to that day told me to wait and not submit the order. Now I'm waiting for my supervisor to call me back because she was confused herself... *sigh*

[Neats, BSN]

You said they had a trial so the dietician and MD should know what that trial revealed.

Stand your ground because if something is amiss it will surely fall on you. I would not set my own trial unless I had orders from the MD to titrate until the agreed amount is over 14 hours. Then I would speak to my supervisor and let my supervisor know I will need to be going back into the home several times throughout the next 28 hours to determine this patient need for nutritional support from the titration.

Make sure you document well so the reimbursement can be made using time increments of 15 mins.

[xoemmylouox, ASN, RN]

That doesn't make sense. The thickness of the formula does not prevent orders being written. What is more likely is that they are not sure how at what rate your patient will tolerate this thicker feeding. Sometimes feeding rates have to be changed depending on how patient's tolerate them, especially when their consistencies change. They should have given you an order with parameters.

That's what I have dealt with in the past with patients.

[KelRN215, BSN, RN]

I don't really see the big deal. Everywhere I've ever worked, nurses adjust the rate of tube feeds all the time. If the patient needs 3 pouches of formula (I'm going to take a wild guess and say this is Nourish which is around 330 mL/pouch), divide the total amount (990 mL) by 14 hours, start at 71 mL/hr and titrate to how the patient tolerates it. I have plenty of patients whose nurses adjust their feeding rates up and down throughout the day depending on what's going on with them clinically and when I was a home infusion liaison, formula orders almost never included a rate because the MD wrote the prescription with 11 refills/for 1 year and they knew that was going to change constantly.