Help? Guidance? Suggestions?

Posted

Has 4 years experience.

Hello all!

I'm looking for some guidance on a situation. I have a new student with a trach in place. Student is self sufficient with almost all care (they are unable to re-cannulate on their own). However, all documentation that we have received from previous school states they are to have a 1:1 nurse to assist with all trach care. These orders are a few years old and mom is adamant that student doesn't need that level of care. BUT, she refuses to provide any new MD orders/documentation and she refuses to give consent for me to speak with MD about student's trach care and emergency plans. As it stands right now, the only information we have received, related to the trach, is CPR (ya know, mouth-to-stoma, not mouth-to-mouth) and that re-cannulation needs to be obtained within 90 seconds if it comes out. That's all. 

Anyone dealt with this situation and have any advice on how to navigate it? 

 

MHDNURSE

Specializes in Pediatrics, Community Health, School Health. Has 25 years experience.

19 hours ago, KeeperOfTheIceRN said:

mom is adamant that student doesn't need that level of care. BUT, she refuses to provide any new MD orders/documentation and she refuses to give consent for me to speak with MD about student's trach care and emergency plans

Is mom aware that unless she provides new MD orders you are obligated by law to follow what is written in the previous orders?  Do you have a 1:1 for the student currently?  

KeeperOfTheIceRN, ADN

Has 4 years experience.

2 hours ago, MHDNURSE said:

Is mom aware that unless she provides new MD orders you are obligated by law to follow what is written in the previous orders?  Do you have a 1:1 for the student currently?  

We have told her that since before school started when we found out about this kiddo. She just kept telling us they didn't need a 1:1 nurse and that she would get documentation stating that. We have received absolutely no MD documentation related to this trach. All documentation we have has been written by mom. We *think* she may have been trying to get one of the doctor's the kid sees to write orders for no nurse but none of them would do it. That is unconfirmed though. After our meeting yesterday, she said she would get orders but she's said she'd get orders since all of this began and we have yet to see any. I don't have any emergency action plans for the kid.

scuba nurse, BSN, MSN, RN

Specializes in School Nursing, Pediatrics. Has 31 years experience.

I would call the doctors office directly and tell them you need orders for this kid. Does he have a 504? 

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

You don't need permission under FERPA or HIPAA to speak to the provider. Communication of PHI without parental consent is allowed by law.

 

Really bizarre that this parent would try to block it. It's almost actionable, I.e. medical neglect...

KeeperOfTheIceRN, ADN

Has 4 years experience.

26 minutes ago, Jedrnurse said:

You don't need permission under FERPA or HIPAA to speak to the provider. Communication of PHI without parental consent is allowed by law.

 

Really bizarre that this parent would try to block it. It's almost actionable, I.e. medical neglect...

And blocking it seems like she is trying to do! She won't even give us dad's contact info to speak to him about anything. All communication is done through her. 

Edited by KeeperOfTheIceRN

lifelearningrn, BSN, RN

Specializes in School Nursing. Has 7 years experience.

It would be a CPS referral at this point for me. You do not take orders from mom, only the child's medical provider(s)!  Her refusal to provide documentation sends up all kinds of red flags. 

Kid does his own suctions? 

2 hours ago, Jedrnurse said:

You don't need permission under FERPA or HIPAA to speak to the provider. Communication of PHI without parental consent is allowed by law.

[...]

Thank you for this.  Not a school nurse, but was curious as to whether thus was legal.

59 minutes ago, lifelearningrn said:

[...]

Kid does his own suctions? 

Possible.  We had a patient in the PICU that changed her trach change, as well as suctioned and performed all of her trach care at 11 years of age.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

Your district needs to contact their legal counsel ASAP.  If you're not providing the 1:1 care, as dictated by the only orders on hand, you're opening yourself and your district up for legal action.  The parent can claim all she wants that the child no longer needs 1:1 care, but until she ponies up the proper documentation from the Dr, then you're on the hook.  I would definitely contact the child's healthcare provider.  They can send you the documentation directly.  If you have the contact info, call.  If you need mom to provide a name and number and she won't, then again, back to legal counsel, and quite possibly CPS, and document everything.  And I mean everything.  Dates, times, conversations, witnesses...