Missing a bolus feeding

[Jlove04]

I work at a home health agency. I care for an infant who is almost two years old.

A few weeks ago I had to skip the last bolus feeding of the day for this patient. This is because the patient wouldn’t remain calm and kept of fighting. I did everything including give her some toys for distraction and placing her in the high chair. None of my techniques worked including sitting her in the high chair which made her more combative. So, for the patient’s safety I missed the feeding to prevent aspiration which could have been caused by excessive motion if I continued with the feeding.

Here is the thing. Another nurse who cares for the patient told me I should have never skipped the feeding. Rather, I should have done my best to make the patient compliant. I’m confused now because I thought I did the right thing to hold the feeding and notify the agency I work for. Plus, the patient was scheduled for a next feeding once her parent returned from work. Was I wrong for skipping the bolus feeding and should I have kept on attempting to feed the child? Also, do you think this can be used against me in terms of competency as a nurse? 

[Sour Lemon]

How long is it (normally) between feedings? How long was it from the "missed" feeding to the parent returning home from work?

In any case, it's difficult to say without knowing much about the child. I have found that someone will always tell you what you should have done ...and in some cases, they are right.

I don't see this as a huge black mark on you. If anything, suggestions about what to do in the future might be helpful.

[Jlove04]

3 minutes ago, Sour Lemon said:

How long is it (normally) between feedings? How long was it from the "missed" feeding to the parent returning home from work?

In any case, it's difficult to say without knowing much about the child. I have found that someone will always tell you what you should have done ...and in some cases, they are right.

I don't see this as a huge black mark on you. If anything, suggestions about what to do in the future might be helpful.

Every 4 hours. The feeding was missed for

7 PM and the mother returned home at 8 PM

[Sour Lemon]

22 minutes ago, Jlove04 said:

Every 4 hours. The feeding was missed for

7 PM and the mother returned home at 8 PM

In that case, I wouldn't get too excited ...especially if it were a one-time occurrence. If it's something that starts to happen frequently, then some trouble-shooting should probably take place.

[caliotter3]

The home environment is not viewed as stringently as a hospital regarding when to do things.  You are at home, not in a prison environment where everything must be done in lock-step (example for explanation only).

Getting off schedule can be a frequent situation.  Parents are usually amenable to moving everything forward and readjusting in increments to bring back to the schedule.  That is how we handle these matters on a routine basis.  So, the feeding would have been given when the parents returned, about one hour late and then the next feeding could have been given a half hour late, and the following feeding, 15 minutes late, and then the next feeding back on time.  For example.

Nobody bats an eye.  You would just document accordingly and make certain to report to the next nurse so that they keep up with the revised schedule.  

I would also discuss at length with the parents ways to calm the patient for feedings.  This is a good topic for the "education" documentation on your nurses note.