Using PRN albuterol medication is ok but what if parents ordered nurses to give it every 4 hours even no adventitious breath sounds? Pt has trach and ventThe doctor denied to prescribed as a continues. Can you please suggest what to do .
It sounds as though you have already notified the physician of the mother's request?
A complete PRN order includes the frequency and the indication. "Q __ hrs as needed for ____________." I would explain to her how PRN orders work, what the indication is and that you aren't authorized to administer it outside of those parameters.
Parents don't/can't order the nurse to change a physician's order in this way.
That said, what is her reasoning? Maybe this is the home routine that she believes is most beneficial? Are her reasons sound or just personal preferences or even mistaken beliefs about the medication's uses and benefits? Her concerns and rationales must be heard and given consideration. At some point the physician needs to discuss it with her; next rounds or a phone call sooner if she doesn't agree with the course of care.
I would guess the doctor refused to order it as scheduled because based on multiple recommendation it shouldn't be ordered as scheduled, only prn. I would explain to the mom the lack of benefit to scheduled dosing, but that it does present the potential for harm. The is particularly important when using albuterol instead of levalbuterol due to the longer half-life of the harmful component in albuterol relative to the beneficial component, and when giving it regularly all you're doing is creating a vicious cycle.
Agree. ^ Hopefully she would easily understand and change her stance once given the relevant information. If she continues to show signs that she is not satisfied with the course of care (even if it's because she's wrong) she deserves to speak with the physician who wrote the order and/or is directing the course of care.
When this occurs in extended care home health (and situations like this occur frequently), and all interventions have failed, the nurse has the option to put her/his foot down and leave the case when they can no longer tolerate being caught in the middle. Not so easily an option in other settings. I would take the matter up with my supervisors.
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