Reported for this?

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So I work Pdn.

Mom makes the formula.

Child has order for Elecare 10 scoops mixed with 1860 water at 80ml/hr via k pump continuous(gtube)

Mom uses a 2000ml plastic container,no label.

The nurses usually just pour the formula into the feeding bag.

Well,it turns out that the new nursing supervisor found out Mom was using Elecare,but also mixing it with regular whole milk instead of water.

Nursing supervisor says every nurse on case is getting written up and reported to BON.

She said nurses should know what they are giving at all times and feeds are no exception.

She said anytime you pour formula(or meds) from an unknown source,and you give it,you take responsibility for whatever is given.

Mom doesn't want us to make the formula.

She said we have to tell mom to pour the formula she made in the bag,doesn't matter if its 3am.

We are not to sign for it either on the feeding schedule sheet.

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Specializes in Complex pedi to LTC/SA & now a manager.

If a parent wants to prepare formula inconsistent with the 485 then the 485 is changed to parent prepares formula and yes agency policy can have parent pour the formula to administer.

Parents wanted formula mixed with pedialyte instead of formula. Parents had to prepare and pour but nurses documented parents prepared formula, reportedly with _______ and initiated feed (filled bag). Nurses circled their initials in the feeding entry which indicates see narrative.

Any nurse that knew the parent was using whole milk instead of elecare can be liable especially since elecare is a dairy free/hypoallergenic formula and adding milk defeats the purpose. One of the indications for elecare is a cow milk allergy.

Nurses signing for the feed administered as ordered is fraud and parent not preparing properly can be fraudulent since this is more expensive and if the patient can tolerate dairy they can use one of the less expensive dairy/whey based formulas. With the current anti fraud act your supervisor has to report to Medicaid/insurance company and may be mandated to report to the BoN for fraudulent documentation.

How did the supervisor find out? Parent? Saw parent prepare? Nurse spoke up?

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If a parent wants to prepare formula inconsistent with the 485 then the 485 is changed to parent prepares formula and yes agency policy can have parent pour the formula to administer.

Parents wanted formula mixed with pedialyte instead of formula. Parents had to prepare and pour but nurses documented parents prepared formula, reportedly with _______ and initiated feed (filled bag). Nurses circled their initials in the feeding entry which indicates see narrative.

Any nurse that knew the parent was using whole milk instead of elecare can be liable especially since elecare is a dairy free/hypoallergenic formula and adding milk defeats the purpose. One of the indications for elecare is a cow milk allergy.

Nurses signing for the feed administered as ordered is fraud and parent not preparing properly can be fraudulent since this is more expensive and if the patient can tolerate dairy they can use one of the less expensive dairy/whey based formulas. With the current anti fraud act your supervisor has to report to Medicaid/insurance company and may be mandated to report to the BoN for fraudulent documentation.

How did the supervisor find out? Parent? Saw parent prepare? Nurse spoke up?

We didn't know......we just poured the already made formula into the feeding bag.

The new nursing supervisor found out because the parent told her.

This is a new agency supervisor because they merged with the old one.

We have old agency 485,with new agency MAR.....been that way since May.

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To me, this is no different that giving someone an injection that someone else drew up and handed you. Once you're the one sticking the needle in the person (or, in this case, pouring the formula into the bag), you're 100% responsible for the medication or formula and its administration. I would not be any more comfortable administering a tube feeding I hadn't prepared myself (or, at least, observed the preparation) than I would be taking an unidentified syringe or tablet from someone else, taking her/his word for what it is, and administering it. I don't care how much I trust the person who is handing me the formula or the medication, it's just bad practice. I'm surprised the nurses there have been agreeable to this practice. My position would be that, if Mom wants to mix the formula, then Mom can administer the formula, and I would be documenting the situation thoroughly.

I'm sorry to say that I agree with the write-ups and report to BON. I hope this will turn out okay for all of you.

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Specializes in Complex pedi to LTC/SA & now a manager.

I watch the one mom prepare the formula at the start of my shift.

Ignorance is no defense especially when it comes to Medicaid fraud. No one ever asked?

Why sign if you didn't ask?

We had a family that pre poured PO meds but left the Rx bottles. I verified each pill with the bottle and a drug database (white oval pull scored RU1233). I was apparently the only nurse that did so and the only nurse that did not get written up for administering unknown/unverified medications. I also check Rx bottles each time I prepare a med. that's how I was the first to know the yellow pill was now neon green due a manufacturer change

You have no defense as administering an unidentified formula you did not witness being prepared goes against the standard of care.

.

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I watch the one mom prepare the formula at the start of my shift.

Ignorance is no defense especially when it comes to Medicaid fraud. No one ever asked?

Why sign if you didn't ask?

We had a family that pre poured PO meds but left the Rx bottles. I verified each pill with the bottle and a drug database (white oval pull scored RU1233). I was apparently the only nurse that did so and the only nurse that did not get written up for administering unknown/unverified medications. I also check Rx bottles each time I prepare a med. that's how I was the first to know the yellow pill was now neon green due a manufacturer change

You have no defense as administering an unidentified formula you did not witness being prepared goes against the standard of care.

.

I guess going forward,I can just write in my notes "Mom prepared formula",or "Nurse on previous shift prepared formula".(for my other cases)

To be honest,on most of my cases(esp nights) formula is already prepared by evening nurse or parent. I rarely see cases where feeding is poured straight into the bag from the can.

I worked with 5 agencies,and nobody ever mentioned this.

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I would never,ever give a pre poured med.

Can a mod move this to the PDN forum?

Just want to see what other Pdn nurses do in these situations.

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To me, this is no different that giving someone an injection that someone else drew up and handed you. Once you're the one sticking the needle in the person (or, in this case, pouring the formula into the bag), you're 100% responsible for the medication or formula and its administration. I would not be any more comfortable administering a tube feeding I hadn't prepared myself (or, at least, observed the preparation) than I would be taking an unidentified syringe or tablet from someone else, taking her/his word for what it is, and administering it. I don't care how much I trust the person who is handing me the formula or the medication, it's just bad practice. I'm surprised the nurses there have been agreeable to this practice. My position would be that, if Mom wants to mix the formula, then Mom can administer the formula, and I would be documenting the situation thoroughly.

I'm sorry to say that I agree with the write-ups and report to BON. I hope this will turn out okay for all of you.

This new agency based in Texas apparently is reporting hundreds of nurses that worked for the defunct agency for various offenses.

The gossip going around is that the new agency realized that the buyout was a mistake,are peeved about it,and taking it out on us.

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Specializes in Pediatrics, Emergency, Trauma.
I would never,ever give a pre poured med.

Can a mod move this to the PDN forum?

Just want to see what other Pdn nurses do in these situations.

If you want to know "what other PDN nurses do", here it is:

As a former PDN nurse, I ALWAYS prepared my feeds, or the nursing staff did per the 485-and verified what was being used by matching up the supplies per the 485 for insurance.

If a parent/caregiver changed the feelings, I always let my supervisor know that they were in the loop.

JBN is a PDN nurse and has an excellent rationale to the situation.

As a PDN nurse, one MUST adhere to standards of care and the 485, as well as exercise prudent nursing judgment when there are alterations in the plan of care and use resources available-or supervisor and provider- to plan or advocate for the pt to make the best decisions for the plan of care.

If anything deviates from it-including the parent wanting control over making feeds-that is to be reported and documented, as well as assessed; ask what and how the parent is handling the POC or procedures-ask for a return demonstration and be prepared to teach or come up with a plan that works in favor of the pt; get the office and the provider involved and go from there.

The supervisor is in a position to report this to the state-blindly allowing a parent, in this case, to make feeds that is not only deviating but the POC, but potentially harming the pt, since Elecare is specifically used for pts who have a milk allergy is bordering on negligence, at least a due to the fact that no one bothered to assess the situation by asking the parent; if they gave resistance, then it is up to the nurse who is basically on the front line to get others involved if the parent/caregiver is being resistant to divulging information and care that may not be in the best interest of the pt.

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Specializes in Complex pedi to LTC/SA & now a manager.
This new agency based in Texas apparently is reporting hundreds of nurses that worked for the defunct agency for various offenses.

The gossip going around is that the new agency realized that the buyout was a mistake,are peeved about it,and taking it out on us.

Then I know what agency you are working for. They are doing a lot of clean up and image repair right now. But the company is investor/venture capitalist owned so know that...

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Specializes in Pediatrics, Emergency, Trauma.
This new agency based in Texas apparently is reporting hundreds of nurses that worked for the defunct agency for various offenses.

The gossip going around is that the new agency realized that the buyout was a mistake,are peeved about it,and taking it out on us.

However...

If this agency is "cleaning house" on those with a valid reason, then it needs to happen; pts in PDN are sicker than ever and need consistent, competent care; just because one works in PDN doesn't mean they can't adhere to best standards and practices just because they are in someone's home. :no:

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Specializes in Complex pedi to LTC/SA & now a manager.
If you want to know "what other PDN nurses do", here it is:

As a former PDN nurse, I ALWAYS prepared my feeds, or the nursing staff did per the 485-and verified what was being used by matching up the supplies per the 485 for insurance.

If a parent/caregiver changed the feelings, I always let my supervisor know that they were in the loop.

JBN is a PDN nurse and has an excellent rationale to the situation.

As a PDN nurse, one MUST adhere to standards of care and the 485, as well as exercise prudent nursing judgment when there are alterations in the plan of care and use resources available-or supervisor and provider- to plan or advocate for the pt to make the best decisions for the plan of care.

If anything deviates from it-including the parent wanting control over making feeds-that is to be reported and documented, as well as assessed; ask what and how the parent is handling the POC or procedures-ask for a return demonstration and be prepared to teach or come up with a plan that works in favor of the pt; get the office and the provider involved and go from there.

The supervisor is in a position to report this to the state-blindly allowing a parent, in this case, to make feeds that is not only deviating but the POC, but potentially harming the pt, since Elecare is specifically used for pts who have a milk allergy is bordering on negligence, at least a due to the fact that no one bothered to assess the situation by asking the parent; if they gave resistance, then it is up to the nurse who is basically on the front line to get others involved if the parent/caregiver is being resistant to divulging information and care that may not be in the best interest of the pt.

Also before reporting to the BoN your supervisor should be contacting the provider ASAP. Elecare is specifically for EE & multiple food allergies especially cows milk. There are whey protein based formulas such as Peptamin 1.5, MCT oil and Pediasure with peptides to increase calories without risking the components of the formula or child's health. Especially a continuous feed.

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