nurse/caretaker suppository legality

[rexun]

I have a family that needs a daily administration of a glycerin suppository to their special needs child. They are trying to find out if legally a nurse is required for this or if a regular caretaker can do this. They have been receiving conflicting information from the agencies that they deal with.

Is anyone clear on the laws about this in Indiana or where they can contact to find the rules about this?

[meanmaryjean, DNP, RN]

By 'regular caretaker' do they mean family member? Because glycerine suppositories are available OTC and don't require much in the way of 'skilz' if you get my meaning.

[caliotter3]

Family members are "trained" to do all manner of skilled nursing tasks in place of a skilled nurse, thus the statement on the plan of care alluding to the availability of a competent caregiver that assumes responsibility when the agency can not provide a nurse.

[rexun]

Non-family member. They work with some agencies that provide people to help with care when they are away.

Haha, it does seem like it should be a non-issue, but they have been told by a couple places that it is a potential legal problem. Some are saying any provider can do it with a doctors orders and some are saying it is illegal for anyone but a nurse. I just don't know who to tell them to contact to get definite information.

[caliotter3]

When I worked in a LTC facility, some of the nurses stated that CNA's could not do anything of an invasive nature, such as insert suppositories (administering a medication) or doing a disimpaction. When I started working in home health, I met In Home Supportive Staff (no CNA or HHA certificate) who "did it all" at less than $10 an hour to save money for the state. I questioned having an unlicensed individual in complete control of the care, both skilled and ADL, of a ventilator dependent person, but my agency managers never gave me a satisfactory answer of how someone could do my job for less than $10 an hour. Said a lot to me about how the State perceives my worth as a licensed professional. I imagine the same attitude could exist in this state.

[meanmaryjean, DNP, RN]

Non-family member. They work with some agencies that provide people to help with care when they are away.

Haha, it does seem like it should be a non-issue, but they have been told by a couple places that it is a potential legal problem. Some are saying any provider can do it with a doctors orders and some are saying it is illegal for anyone but a nurse. I just don't know who to tell them to contact to get definite information.

Is there some reason a family member cannot do this? Surely this child lives WITH someone, right?

[BeckyESRN]

An RN cannot delegate medication administration. If they are going through an agency, this is considered a skilled procedure, which will require at least an LPN. OTC or not, it's a medication. If they're hiring a private unlicensed care giver then I'd be up to that person's level of comfort

[meanmaryjean, DNP, RN]

An RN cannot delegate medication administration. If they are going through an agency, this is considered a skilled procedure, which will require at least an LPN. OTC or not, it's a medication. If they're hiring a private unlicensed care giver then I'd be up to that person's level of comfort

I'm not sure this is a case of delegation- seems (maybe I'm misreading) that the patient has unlicensed assistants in home- no RN direction. It seems like a no-brainer that a family member could do this if the UAP are unwilling or unable.

[chocoholic1]

I don't know about legal or illegal, but it is likely the agency the caretaker works for that has decided they can't do it just because of any potential liability issue. The caretaker is probably just following agency policy. I agree that maybe a family member should do it or they can look to hire from a different agency. As someone else mentioned there are suppositories sold OTC and the procedure doesn't require special training..

[brownbook]

It is covered by the agencies policy, and most likely the caretakers are told absolutely to not give any medications. Many non-medically fragile special needs children can be home alone with just the caretaker after school or for respite care on weekends while parents do errands. But I can't figure why the parents can't find time to give a a once a day suppository, unless needs to be given at a special time?

But it is not at all easy to just find another agency. My daughter has been through hell and high water several times the past 9 years arranging caretakers for their son. (I have had to drop everything and do emergency babysitting for a week or two. Unfortunately I don't live close by.) She lives in a large metropolitan area, just not that easy to get reliable caretakers, or they are just with the agency while they finish school so lucky if you can get one year of the same person. (Many are nursing students.)