G-tube medication delegation

[Mavnurse17, BSN, RN]

For my fellow Texas school nurses--

Anyone know if medications that go down a G-tube (mickey button with extension set) can be delegated to trained UAP's?  I've tried searching the TX BON for this guidance but can't find it specific to crushing and pushing these down the G-tube.

I will be on maternity leave starting next semester and my school won't have an RN to fill in, and due to the pandemic we're limiting nurses "popping over" for procedures.  I have a student coming to our campus that has orders for G-tube medications q 2 hours, so if it can't be delegated and doctor won't reschedule those med times for outside school hours, I'm not sure what will happen. 

Can any TX nurses advise?

[ruby_jane, BSN, RN]

Welcome to my peeve about Texas nursing: we are an extension of the home environment so things that are not usually delegated in the nursing world may be delegated!

You're right, the Board is a little ish-y about this.

I do not consider medication by g-tube to be delegable, although I do consider the tube feed delegable. However, what I think is delegable doesn't really matter: What does your policy say? I would start with your health services director to see if there's a protocol you can use. It's also a FAPE thing (meaning your boss may have to produce a nurse). I guess now I'm curious about meds via g-tube every two hours!

You may consider g-tube meds delegable, BTW. I won't judge - it's kind of an individual nursing decision and you may have fully competent staff...but when we give a medication, no matter how benign, we have to assess for any possible reaction and an unlicensed delegee is unable to assess.

Good luck!

[Mavnurse17, BSN, RN]

5 minutes ago, ruby_jane said:

Welcome to my peeve about Texas nursing: we are an extension of the home environment so things that are not usually delegated in the nursing world may be delegated!

You're right, the Board is a little ish-y about this.

I do not consider medication by g-tube to be delegable, although I do consider the tube feed delegable. However, what I think is delegable doesn't really matter: What does your policy say? I would start with your health services director to see if there's a protocol you can use. It's also a FAPE thing (meaning your boss may have to produce a nurse). I guess now I'm curious about meds via g-tube every two hours!

You may consider g-tube meds delegable, BTW. I won't judge - it's kind of an individual nursing decision and you may have fully competent staff...but when we give a medication, no matter how benign, we have to assess for any possible reaction and an unlicensed delegee is unable to assess.

Good luck!

Thanks Ruby!  I can always count on you.

The previous school she was at (a specialty school for SPED students here in the state) said they weren't able to delegate G-tube medications.  I'm embarrassed to say, but I'm not sure if that was a policy specific to them or a BON thing, so I took to researching it but as I said, there's no real clear info so womp womp.

My own district policy doesn't specify this either... we have policy for delegable Diastat, asthma inhalers, oral medications (would G-tube meds also qualify as 'oral'? Hmm...) epi pens, and insulin.  Tube feeds are also delegable and I've done so in the past. 

Her current med list perplexes me though... they are scheduled BID or once daily, so they should be able to be given at home.  IDK where this other school got that they're Q2H.  So, parent is supposed to update me on that ? 

I guess I will end up having to ask my supervisor about this, which is fine.  I just wanted to see if I could find the answer myself though before I bothered her ?

[ruby_jane, BSN, RN]

1 hour ago, Mavnurse17 said:

Thanks Ruby!  I can always count on you.

AWWW. You're welcome!

The previous school she was at (a specialty school for SPED students here in the state) said they weren't able to delegate G-tube medications.  I'm embarrassed to say, but I'm not sure if that was a policy specific to them or a BON thing, so I took to researching it but as I said, there's no real clear info so womp womp.

Don't be embarassed. You did the diligence. There may not be an answer.

My own district policy doesn't specify this either... we have policy for delegable Diastat, asthma inhalers, oral medications (would G-tube meds also qualify as 'oral'? Hmm...) epi pens, and insulin.  Tube feeds are also delegable and I've done so in the past. 

If it's not specifically delegable then they are not delegable.

You've done your best. Now it's time for the people who make more money than us to weigh in!

 

[KeeperOfTheIceRN, ADN]

Another Texas nurse here, and while I can't offer any better guidance than Ruby did, I'm relieved to know I'm not the only one who struggles finding specific guidance via the BON!! There have been multiple times that I have not be able to find the guidance I needed and its super frustrating. I hope you get the help you need and congratulations on your new baby!!