"Eyes & Thighs"

  1. By "Eyes & Thighs" I am referring to the Vitamin K injection and antibiotic eye ointment that are routinely administered to newborns shortly after the birth.

    Where I work, we have a significant incidence of refusal of these medications by the parents. Often the parents have never even heard of them prior to their arrival to the hospital for the birth. That is a huge part of the problem. Isn't it the provider's responsibility to explain the purpose of this treatment to parents before the birth so that they at least have true informed consent should they decide to accept or refuse the treatment?

    I'm not saying that we aren't responsible for educating our patients....but, I have found that during labor or shortly after the delivery is a terrible time to explain these medications to the parents. The parents tend to be exhausted and/or distracted and are often unable to process the information. I was wondering if other nurses have this same issue and how you deal with it?

    Do you have written material to give to patients that explains the benefits/risks of this treatment in words that non-medical folks really understand? I'd like to put something like this together and was wondering if anyone had any examples from their facility. Thanks for any responses!
  2. Visit RootedRedwood profile page

    About RootedRedwood

    Joined: Mar '08; Posts: 72; Likes: 96
    OB nursing
    Specialty: Antepartum, L&D, Postpartum

    18 Comments

  3. by   country mom
    When I had my kids, I had to go up to the OB unit a week or two before my due date for a "pre-admit". The nurse discussed that, and immunizations with me, and pretty much everything else r/t the delivery and post-care. I thought it was great patient teaching. They had my whole teaching plan and plan of care ready before the day came, and I signed the consent for the meds and everything then. I don't know if all OB units do it that way, but as a patient, I thought it was great.
    Last edit by country mom on May 6, '09 : Reason: addition
  4. by   CoffeeRTC
    I'm on baby #5 and I don't think I was ever formally informed of what happens to the baby (as a nurse, I know) Maybe push the obs to include this in prenatal care visits?
  5. by   mjjlRN
    Quote from country mom
    When I had my kids, I had to go up to the OB unit a week or two before my due date for a "pre-admit". The nurse discussed that, and immunizations with me, and pretty much everything else r/t the delivery and post-care. I thought it was great patient teaching. They had my whole teaching plan and plan of care ready before the day came, and I signed the consent for the meds and everything then. I don't know if all OB units do it that way, but as a patient, I thought it was great.
    In my hospital, Consents are only valid for 24 hours. Otherwise, I think is a great idea for those who have planned births (either c-sections or inductions) Not so practical for those with more complicated deliveries such as pre-term labor.
  6. by   eden
    I don't think it's a big deal to explain these to the parents at the time of recovery. It's a simple explanation and they are free to decline both. Many times I will have parents refuse the eye ointment but rarely will they refuse the vit. K and I have never had a problem explaining it after delivery.
  7. by   SmilingBluEyes
    Quote from RootedRedwood
    By "Eyes & Thighs" I am referring to the Vitamin K injection and antibiotic eye ointment that are routinely administered to newborns shortly after the birth.

    Where I work, we have a significant incidence of refusal of these medications by the parents. Often the parents have never even heard of them prior to their arrival to the hospital for the birth. That is a huge part of the problem. Isn't it the provider's responsibility to explain the purpose of this treatment to parents before the birth so that they at least have true informed consent should they decide to accept or refuse the treatment?

    I'm not saying that we aren't responsible for educating our patients....but, I have found that during labor or shortly after the delivery is a terrible time to explain these medications to the parents. The parents tend to be exhausted and/or distracted and are often unable to process the information. I was wondering if other nurses have this same issue and how you deal with it?

    Do you have written material to give to patients that explains the benefits/risks of this treatment in words that non-medical folks really understand? I'd like to put something like this together and was wondering if anyone had any examples from their facility. Thanks for any responses!

    A clear case for PRENATAL EDUCATION that discusses risks/benefits to such interventions! If they have doubts or hesitation, particularly the Hep B immunization, I ask them to defer until such time we can provide the handouts and education needed for them to make informed choices pro or con for their babies. You are right; active painful labor is a terrible time to have to explain these interventions, but you do have time right after birth to further discuss these things---in that first hour or two, to help them come to a decision regarding eye meds and shots.
  8. by   RootedRedwood
    Quote from country mom
    When I had my kids, I had to go up to the OB unit a week or two before my due date for a "pre-admit". The nurse discussed that, and immunizations with me, and pretty much everything else r/t the delivery and post-care. I thought it was great patient teaching. They had my whole teaching plan and plan of care ready before the day came, and I signed the consent for the meds and everything then. I don't know if all OB units do it that way, but as a patient, I thought it was great.
    That sounds really great- I'll have to ask my nurse manager if we can fit something like that in to our unit. We currently have no "pre-admit" at all.
  9. by   RootedRedwood
    Quote from mjjlRN
    In my hospital, Consents are only valid for 24 hours. Otherwise, I think is a great idea for those who have planned births (either c-sections or inductions) Not so practical for those with more complicated deliveries such as pre-term labor.
    At our hospital the parents do not sign consents for the baby meds....they only have to sign a form if they refuse the medications.
  10. by   RootedRedwood
    Quote from SmilingBluEyes
    A clear case for PRENATAL EDUCATION that discusses risks/benefits to such interventions! If they have doubts or hesitation, particularly the Hep B immunization, I ask them to defer until such time we can provide the handouts and education needed for them to make informed choices pro or con for their babies. You are right; active painful labor is a terrible time to have to explain these interventions, but you do have time right after birth to further discuss these things---in that first hour or two, to help them come to a decision regarding eye meds and shots.
    I agree that there is usually adequate time (just not quality teaching time) during the recovery to discuss interventions ....and I personally haven't found it particularly difficult to verbally explain the interventions, including risks and benefits. I am finding that people have a hard time processing all the information and sometimes appear to refuse treatment because they are too overwhelmed at that moment. And unfortunately delaying those meds decreases their efficacy (we are supposed to give Vit K within the first hour and eye ointment before the second hour is over). Its fine if they want to refuse the treatment, I just want them to make a truly informed decision.

    The best scenario is prenatal education but of course we know that doesn't always happen. For some people, verbal explanation just doesn't do it- they need to read something that is formally put together. The baby meds are probably the only thing we don't have written information on for parents and I was curious if anyone else is using written info in addition to a verbal explanantion?
  11. by   ragingmomster
    Once again I am struck by the paternalistic medical system within which I work.

    We recently had a pediatrician call a social work consult and insist on interference with parental control because mom refused to allow staff to give erythromycin following birth.

    More disgusting to me was the charge RN who suggested to another RN shat she just do it, and don't tell the parents because it "can't cause any harm".
  12. by   KateRN1
    As an educated mom who has refused both Hep B and Vit K for my baby (who is now a happy and healthy unvaccinated two-year-old) please don't assume that those parents who refuse these unnecessary procedures are uneducated. Informed consent is great and it's absolutely important that parents understand the healthcare provider's rationale for wanting to administer them, but it's also important that HCPs understand that it's the parents' decision. Administering a drug to a baby whose parent did not consent is illegal. Whether or not the administration of the drug causes harm is irrelevant.
  13. by   MichelleB34
    At my hospital we only obtain a specific consent for the hepatitis B. I think the other meds are covered under the consent for admission to the hospital for medical treatment. But of course the parent could refuse the medications. I have only seen a few parents refuse the hepatitis B vaccine so far.
  14. by   cjcsoon2bnp
    Quote from KateRN1
    As an educated mom who has refused both Hep B and Vit K for my baby (who is now a happy and healthy unvaccinated two-year-old) please don't assume that those parents who refuse these unnecessary procedures are uneducated. Informed consent is great and it's absolutely important that parents understand the healthcare provider's rationale for wanting to administer them, but it's also important that HCPs understand that it's the parents' decision. Administering a drug to a baby whose parent did not consent is illegal. Whether or not the administration of the drug causes harm is irrelevant.
    I know its a bit OT but just out of curiosity Kate do you plan on ever vaccinating your child for any disease or are you against vaccines completely?

    !Chris

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