Looking for Guidance on Mistake

[katie115]

I am a new nurse in the NICU, and I'm just trying to decipher whether or not I made the right call.

I had a patient being discharged to absentee teen parents. They had difficulty obtaining a car seat, didn't have adequate transportation, and so on. Because the parents didn't bond in the NICU with their baby, they had no idea what to do or how to prepare for homecoming.

Anyway, the patient was supposed to be discharged at 0900, but when I came onto shift at 1900, nothing had been done because the parents had not come to the bedside. When I finally discharge them at 2230, I find out that they have no formula for the baby. When I asked them what the plan was, the mom stated she was planning on going to WIC in the morning for formula. The baby has to eat at night, right?! So I decided to give them formula to last overnight and she promised to go to WIC first thing the morning.

Now, this was probably a horrible idea in hindsight because that puts my facility at a very real risk of losing their baby-friendly status. Maybe I should have involved social work (sometimes on call at night)? My charge nurse was in an assignment and also helping with admissions, and I just didn't think to involve her in something with a 'simple' solution.

Additionally, because this was such a prolonged discharge, I was feeling pressure to 'get it done' and accept a new baby transitioning from Level III to Level II status, and the housekeeper was only available to clean until 2300.

I plan on talking to my manager, who is aware of the situation, but I guess I'm just looking for any sort of reassurance because I do know I was wrong (by the books), but I can't help but feel like I did what was best for the patient--what would you have done?

Thanks for your feedback.

[pigginsrn]

A mistake to provide food for a baby?? What could be more "baby friendly?"

[Here.I.Stand, BSN, RN]

I'm not a NICU nurse, but FWIW I think you did the right thing. What were you supposed to do to be more "baby friendly," help establish breastfeeding?? At this point, of course not -- that ship has sailed. And what would the SW have done, had you been able to get ahold of one? The parents'/baby's immediate need was for....formula.

Baby needed to eat. Food is farther down Maslow's heirarchy than "baby friendliness."

[rnkaytee]

I don't see anything wrong with what you did about the formula, although we probably would've delayed the DC until the next day instead of doing it in the middle of the night (but that's our hospital).

[KRVRN, BSN, RN]

I would have given her formula.

[debstmomy]

Our hospital is baby friendly in Postpartum only, not NICU. We give out formula all the time. Many times new parents do not have time on day of discharge to prepare at home. This buys them time to get settled. I'd be more concerned to discharging to parents that do not seem capable to care for their infant. I would make sure social work follows up.

[nurse2033, MSN, RN]

It sounds like case management should have been involved before it led to this situation for you.

[OrganizedChaos, LVN]

I'm not a NICU nurse but I believe you did the right thing. I don't understand how there could've been anything else done. But I like debstmomy suggestion, have social work follow up with them. You know what the red flags were, so I think it is important to make sure nothing happens.

[katie115]

Social work is absolutely involved and following up on their case. The parents didn't have inappropriate bonding, they just lacked adequate transportation to get to their baby after mom was discharged (not uncommon, I work in a widely low-income area). Frankly, I think they just weren't prepared food-wise for their first night home! I plan on talking to my manager on Monday and explaining the situation to her. Thanks again for everyone's insight!

[fulitarn, BSN, RN]

If the baby is formula fed while in the NICU, we always send enough formula home for the first day. I think you made the right call and you should not be worried about it. Baby-Friendly allows formula for parents who refuse or can't breastfeed.

[BittyBabyGrower, MSN, RN]

First off, discharging late at night is a bad idea. We would have held off discharge. What was the baby eating when he/she was there? I'm guessing formula since the parents/mom wasn't in too often. And depending on the insurance they have, social

worker can set up X amount of transportation rides in to the hospital. I know that Caresource does this.

I work in a large inner city hospital. We have instituted mandated discharge classes, parents have to bring in the car seat prior to discharge (if they do not have access to one, they are given the names of organizations to get one at no to low cost), we make sure they have WIC lined up and provide 24 hours worth of formula, we keep vitamins in our Pyxis to give at discharge instead of sending them to pharmacy. If they haven't been in for a while or are infrequent visitors, they have to come and spend at least 2 feeds with the baby.

As as for pushing you to discharge because housekeeping was only there until 2300, are you kidding??? Housekeeping shuts down or what? And we clean our own spots if they are back logged and we need spots.

Maybe be you could talk to your manager about starting up a discharge committee. We work with the neo who runs our follow up clinic and over the years have developed all the things I listed. We do discharge rounds to see who is going home, what they need, what follow up they need, things like that. Makes discharge a lot easier!

[Luvbuble]

You are a nurse not God, there is just so much you can do. You did the right thing. These teenage kids will learn their way to deal with problems. Don't feel bad. The parents of these kids should feel bad. It is their responsibility to raise their kids and help them out.