I hope to gain some clarification from some of you, as my agency is not very helpful, and I generally get the impression to keep my head down and stop approaching them with questionable procedures.
I am one of several nurses on duty for a peds pt who has complex medical issues. She has nursing care ordered 20 hours/day, and I am the only RN. I don't take this to mean that I have any charge over the case. We have a CCM, and we all share responsibility, although I have not been oriented well to all of the procedures for all of the shifts, so I only do trach care, suctioning, vitals/ g-tube meds, wound care. My primary experience has been in psych, so when I started, I was/am rusty with clinical skills, but I've been doing fine. Anyhow,
I questioned a few things:
1] we didn't have a written MD order for some meds, just the pharm label. I was told that in " home health we do things differently" and the label was fine to serve as an order. Is this true? How do we know that the pharm transcribed the order correctly? For example, one label said 10ccs PO q 6h until bottle finished, but the pt only takes meds via g-tube.
2] There is an order to change out the G-tube, I think q month...and I always thought that this was a doctor's office visit. A few weeks ago I was talking to the guardian who told me that XX, who is an LPN has always changed out the G-tube. I asked again if she meant the WHOLE thing, not just the Mickey xtension set, and the guardian said yes, the whole thing. I've ALWAYS thought nurses except ARNPs were prohibited from changing a G-tube. Is home health different in this respect also....maybe because of the frequency of the order?
I'm sorry for the long post. Appreciate any insight, and also any other procedures/treatments that you can think of that are different in HH from the hospital. People are telling me I need to chill out, and that's fine if this is all on the up and up, but I want to stay well within the Nurse Practice Act.
SunnyPupRN
289 Posts
I hope to gain some clarification from some of you, as my agency is not very helpful, and I generally get the impression to keep my head down and stop approaching them with questionable procedures.
I am one of several nurses on duty for a peds pt who has complex medical issues. She has nursing care ordered 20 hours/day, and I am the only RN. I don't take this to mean that I have any charge over the case. We have a CCM, and we all share responsibility, although I have not been oriented well to all of the procedures for all of the shifts, so I only do trach care, suctioning, vitals/ g-tube meds, wound care. My primary experience has been in psych, so when I started, I was/am rusty with clinical skills, but I've been doing fine. Anyhow,
I questioned a few things:
1] we didn't have a written MD order for some meds, just the pharm label. I was told that in " home health we do things differently" and the label was fine to serve as an order. Is this true? How do we know that the pharm transcribed the order correctly? For example, one label said 10ccs PO q 6h until bottle finished, but the pt only takes meds via g-tube.
2] There is an order to change out the G-tube, I think q month...and I always thought that this was a doctor's office visit. A few weeks ago I was talking to the guardian who told me that XX, who is an LPN has always changed out the G-tube. I asked again if she meant the WHOLE thing, not just the Mickey xtension set, and the guardian said yes, the whole thing. I've ALWAYS thought nurses except ARNPs were prohibited from changing a G-tube. Is home health different in this respect also....maybe because of the frequency of the order?
I'm sorry for the long post. Appreciate any insight, and also any other procedures/treatments that you can think of that are different in HH from the hospital. People are telling me I need to chill out, and that's fine if this is all on the up and up, but I want to stay well within the Nurse Practice Act.
Thanks!