Possible adult admit with minor child in tow

[Monkey Nurse]

I work in a rural and impoverished community. Our circumstances are unique and things happen here that shouldn't or wouldn't happen other at 'normal' places.

Anyways-- I was being asked to take an admit on the inpatient floor which I refused with the charge nurse blessing, because she had a minor child with her (less than 12y/o). They had no one to come get the girl and I said I can't admit a patient and just have her kid hang out here.

What does a normal hospital policy look like in regards to patients who present to an emergent care facility and then need admitted?

[JustBeachyNurse, LPN]

The RN on the Ortho Unit mentioned that, in an emergency, she could have obtained diapers from the hospital's Pediatric Unit. I was wondering why the mom and babe were not admitted to the Peds Unit? In most hospitals, that is where mom's and newborns are usually admitted, if either the mom or the newborn have medical issues a few days post discharge from the Mother/Baby Unit. Pedi Units are equip to handle both children and women, especially postpartum women who develop medical issues.

I fully realize that CPS could be called to temporarily take the baby, or small child/children. However, the fear factor, especially for a poor family, would make an all ready, apprehensive, and sick mother even more anxious.

Not so much CPS to take temp custody but CPS has stronger connections and resources to seek out family that can care for the child of a sick parent rather than what feels like punitive emergency custody can turn out to be specialized search skills to locate family that maybe has unlisted numbers or different last names that an ill parent can't communicate contact info

What would be the benefit of admitting an adult parent to a pediatric unit simply because there is no adult present to care for an otherwise well child

[Mia415]

Yikes sorry to hear OB wouldn't take her!! I currently work in maternal child health and actually up to as many as 30% of preeclampsia cases occur postpartum! Every Pospartum or antepartum unit in my area that I have worked it would handle that patient because they are more familiar with the diagnosis and management. It sounds like you handled the situation well!

[CHESSIE]

(Quote)

What would be the benefit of admitting an adult parent to a pediatric unit simply because there is no adult present to care for an otherwise well child

Most of the Pedi Units, in my area, are where newly discharged moms and babes are admitted if either the mom or the babe has a medical issue after the mom and babe have been discharged from the Mother/Baby Unit, AKA Maternity/Postpartum Unit. In this state once the mom is discharged from the Mother/Baby unit she cannot be readmitted to that unit, as there is an infection risk.

This was not at all unusual, although I'd not seen a pre eclampsia admit post partum, we did have mom's with DVTs or babes with high bilirubins admitted to the Pedi Unit.

As for other babies being admitted without being ill, I can cite one case albeit it was unusual. A child was quite ill necessitating frequent admissions with longer than usual hospital stays. The mom stayed with the child, on each and every admit, she helped with homework and the child would have a tutor once stable. She gave birth to another child, during her older child's well period, and brought that child with her if the older child needed to be admitted. She was a nursing mom and accommodations were made for her and the baby in her older child's room. They were, and still are, a fabulous family and so appreciative that we could go the "extra mile" for them. A bassinet was loaned to Pedi from the Mother Baby Unit and later, when the baby was too large for the bassinet, a crib from Pedi was used.

As for bringing two or more young children with a parent who needs to be admitted, these types of situations are different. Probably CPS would need to be notified. Sadly, in our area, CPS is seen as "punishment," for a parent who cannot properly take care of his or her child.

[Mia415]

In regards to non OB units accepting the preeclampsia patient... I say this with respect and I understand different hospitals have different policies but never in my life have I heard of a woman with an obstetric complication go to peds. I know that some places admit them to adult med surg, but nurses trained in L&D or postpartum need to be caring such a patient and running mag. It is absolutely absurd to say a healthy woman presenting with high blood pressure or preeclampsia or PPH without a contagious disease is any sort of infection risk to other women. That is not evidenced based practice. Almost every hospital I've ever heard of have sort of blend of protocol to admit to antepartum/LD/PP/high risk maternity unit, and only go off unit if OB is full and they are low risk. Magnesium administration requires 1:1 staffing and hourly VS checks. Just sharing my maternity experience.

[RainMom]

I was wondering why the mom and babe were not admitted to the Peds Unit? In most hospitals, that is where mom's and newborns are usually admitted, if either the mom or the newborn have medical issues a few days post discharge from the Mother/Baby Unit. Pedi Units are equip to handle both children and women, especially postpartum women who develop medical issues.

We're a relatively small facility, 100 beds or so. It's not unusual for our peds unit to be closed which may have been the case at that time.

[qnmimi]

Rule of thumb in our hospital is, if infant/toddler & up to young school age, there must be another adult to care for that small child. An older child who needs minimal supervision, and the pt basically has the physical, and mental capacity to care for this child is OK ( think older school age) Sometimes saying no is hard, but most nurses would refuse to take on the responsibility of a non patient. This also applies to elderly folks who need care from the patient too. We often do make arrangements for an elderly spouse to stay, but again, we firmly do not accept the responsibility of the legal side of care for a non patient regardless of age.

[LVP_RPN]

About a year ago the hospital I work at began trialing a new policy that allows a breastfeeding baby under 6 months of age to stay with their mother if she needs to be re-admitted. We do our best to admit her to the mother/baby unit. So far it's worked quite well. We don't have a policy that I'm aware of in regards to older children.

I remember one patient with spinabifida admitted for UTI treatment, she had two school aged children (maybe 8 and 10), that would be dropped off around 0800 and just hang out with her in her room all day and get picked back up around 2100. It was really awkward, but no one really said it did anything about it.