Please advice

[hrithrik]

Hello all,

Please advice,

Scenario:

JS is on peg feed as,he is a great risk as aspiration.Due to weight loss Dietician take the decision on increase JS flow rate on his feed machine from,100 to 200 ml/hr.Decision in increasing the flow rate is given over the phone to a colleague ,and to start this new regime from next day.As Dietician doesn't follow information given over the phone with a letter in writing ,the nurse in charge next day decides to stuck with old regime, as not confortable with starting new regime without a confirmation in writing from Dietician.Home Manager steps in and advice the nurse in charge that JS has to start new regime as adviced by Dietician over phone.

Ok,...I'm lost, me I'm not confortable with this but home manager force me to do it ...

In a coroner investigation,who is the person responsible,if JS dies without in writing confirmatin ,due to ?overflow lets say.

This is just an example I wanted to highlight ,but obviously there are so many others...

Thank you.

D

[Been there,done that, ASN, RN]

Since when can a dietician write an order ? They make recommendations.

It is up to the caregiver to decide what is appropriate ..after consulting the physician.

[JustBeachyNurse, LPN]

Dieticians can only make recommendations. The physician must issue the order. If you do not take an order (verbal or written) from the physician you don't have a leg to stand on, regardless if the dietician follows up with a letter detailing his/her recommendations.

[Double-Helix, BSN, RN]

This sounds like a nursing home or home are situation. Are you in the USA? In all states that I'm aware of, dietitians cannot initiate new orders- that needs to be done by the physician. So unless the doctor had written the order to increase the rate of feeds, it should not be increased. If the nurse changed the rate without a signed order, then she would be liable for any harm that came to the patient, regardless of the recommendation of the dietician.

However, any time the rate of a feeding is changed, the nurse should be checking residual volumes to make sure the patient is tolerating the new rate and the stomach is not becoming overfilled- increasing be risk of aspiration.

[#1ME]

I wouldn't do it without an order from the MD. Dieticians can make recommendations all day long, but without an MD order, they mean nothing. You can call the MD to personally inform him of your assessment of the Pt, and the recommendations of the dietician, then clarify an order for the rate.

[Sun0408, ASN, RN]

In the states, I wouldn't do it without a MD order. If he is at great risk for aspiration; 200ml/h sounds way too high. I have many many pts on TF and none at that high of a rate. Anyone else ??