Reported for this?

Specialties Private Duty

Published

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.

A good supervisor would have addressed the situation with the mother, explaining to her, and providing education regarding, following the orders on the 485. The supervisor would have then contacted the PCP to report what was occurring. She would have obtained any clarification of orders or change in orders. Then, the supervisor would have reported to all nurses on the case, what transpired, talking to individuals to find out what their role in the situation was. If necessary, she could have counseled the nurse(s) who failed to take up the matter in an appropriate manner.

This overkill, overreactionary report to the BON baloney would never have crossed anyone's mind, no matter what house they were trying to clean, or who they were trying to impress. But then, that is what a good supervisor would have done. (Couldn't help but make this observation).

Up Vote Up Vote ×

Sounds to me like Mom had no clue. And that would be on the nurse who signs off on educating Mom on how to prepare feeds.

Which may or may not have made one bit of difference.

Parents sometimes don't get it. The formula is expensive, paid for by insurance, and there are parents who think "milk" (formula) really means literally milk. Equally, some parents really want control over something--and can resent any nurse who "tells them how to take care of their child".

And the whole "don't want us in the kitchen like that"--again, control issues.

Going forward, I would look at the original MD order. I would look at who educated Mom on how to mix the formula, or was this just something that she came up with in an effort to do the "right thing" (as there are parents who believe milk is essential, whole milk at that)

And have no clue the connection between a lactose intolerance and milk.

How has the kid been tolerating? Because now is the time I would think for a review. If the formula which is xx amount of calories has now been mixed (for a year) with whole milk, it increases the caloric intake. So to change that now could mean any number of things for the patient. Additionally, is there such thing as a held harmless liability form for parents who want to "medicate" on their own? And I am thinking along the lines of when a family prepours a medication box in HH. You "assist" in the administration of said meds from box. And it could be anything in there--some nurses will check the pre-pour box but not all. So there's usually a liability form regarding family prepared medications.

And 4 am is a difficult time to wake up the house to question the making of a formula.

Is there a sink in the room of this child? Can everything be left in the room for preparation? Because when you come in, there's a feed running. You just verify the feed running at such and so per minute, that there's no patency issues and that the child is tolerating. Then comes time to prepare a new batch of formula.

So, certainly not medical advice or telling you anything other than for the sake of example, if 1860 is the volume, (near 2 liters) then 930 would be half that, or almost 1 liter. So half of that would be 465--so I would think that for your shift, and a max volume of 500 mls I would break that order down, and get some clarification from MD on it to be able to do so. Seems foolish to me that we are talking about almost 2 liters made at one time when it is doled out in 500 ml doses. Because at the end of the day one could argue that who knows if the container it is kept in is clean, that it isn't just kinda rinsed out (or not at all and a new batch is just put into it) that the fridge is at the proper temperature to hold the feed--this could go on and on.

The ignorance of a parent should not reflect on all of the nurses. Especially when no one is allowed in the kitchen and 2 liters of feed are being prepared at one time that is not all used each time. And education for the parent. Who told her to mix the stuff with milk? Or was this a thought in her own head?

So instead of "reporting to the BON" lets go forward with perhaps new orders, a consult on how to wean the child off of perhaps twice the caloric intake, and seriously, if the "special formula" is mixed with milk without incident, one would question the tolerance, and does the child even need this "special" formula anymore? And an order that is more realistic to the amount of volume hung at one time. Because any formula sitting around will be prone to souring and/or growing stuff. And don't forget--this could mean a change in bowels, if you are giving any fiber due to really loose stool, the child seems uncomfortable hence why it was put down to 500 ml total volume, lots of things.

I don't think this is a matter of a nurse not doing due diligence. I think it is more like Mom is going to do what she is going to do, and in home care, there is only so much a nurse can control. Especially the night nurse.

Up Vote Up Vote ×

Going forward, I would look at the original MD order.

I would look at who educated Mom on how to mix the formula, or was this just something that she came up with in an effort to do the "right thing" (as there are parents who believe milk is essential, whole milk at that)

And have no clue the connection between a lactose intolerance and milk.

How has the kid been tolerating? Because now is the time I would think for a review.

The ignorance of a parent should not reflect on all of the nurses.

I believe its just "something" she thought might be a brilliant idea.

All of these calories,but pt gained 2 pounds in 6 months.

Pt is between 10-13 yrs old.

Child seems to actually tolerate it,but then again we don't know how long she has been adding milk.

As far as bm,pt gets daily Glycolax powder,so even if the formula made them constipated,we would not know. Pt has bm daily.

Up Vote Up Vote ×
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...

Are most of them like that?

Well,I know the big "M" is anyway.

Up Vote Up Vote ×
Specializes in Home Health (PDN), Camp Nursing.

Having things on the 485 but not in the MAR or Any other shift to shift document sheets is another hallmark of the big "M" as well.

Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.
k pump bag only holds 500 ml.

Plus,we were told we can no longer add more than 4 hrs of volume,due to bacterial growth.

So we can only add 280ml every 4 hrs to the bag.

I was picking random numbers. And kangaroo pump bags come in 1000 and 500mL. 500mL is more common in pediatrics

Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.
Are most of them like that?

Well,I know the big "M" is anyway.

No. Epic is like that I know at least 3 others are NOT.

Epic is a company owned by Webster Capital (capital investment group) Webster Capital

Big M is privately owned and doesn't appear to be owned by venture capitalists

Up Vote Up Vote ×
Specializes in RN, BSN, CHDN.

Moved to Private Duty Nursing forum at the request of the OP

Up Vote Up Vote ×
I was picking random numbers. And kangaroo pump bags come in 1000 and 500mL. 500mL is more common in pediatrics

My pt is a PEDs pt.

The volume of the bag doesn't matter.

If a client is getting feeds over 4+ hours,we can only add 4 hours worth of volume,then keep refilling every 4 hours.

For the example in the first post,we can only put 320 in the bag every 4 hours.

Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.
My pt is a PEDs pt.

The volume of the bag doesn't matter.

If a client is getting feeds over 4+ hours,we can only add 4 hours worth of volume,then keep refilling every 4 hours.

For the example in the first post,we can only put 320 in the bag every 4 hours.

The point was not the volume but simply a suggestion how you can document what is running when you arrive. As far as adding to bag some policies and care plans limit 2 hours at room temp for non commercially mixed formulas (such as elecare, adding water to Peptamin, blended puréed stored in a fridge) as opposed to adding from a sealed bottle of Peptamin or Nutren.

Many posters have offered legal work arounds to document and follow the standard of care and when to call the physician/provider to get an order amended. Nothing more.

Up Vote Up Vote ×
The point was not the volume but simply a suggestion how you can document what is running when you arrive. As far as adding to bag some policies and care plans limit 2 hours at room temp for non commercially mixed formulas (such as elecare, adding water to Peptamin, blended puréed stored in a fridge) as opposed to adding from a sealed bottle of Peptamin or Nutren.

Many posters have offered legal work arounds to document and follow the standard of care and when to call the physician/provider to get an order amended. Nothing more.

I think I got mixed up.

Someone suggested letting mom pour the total volume needed for the 8 hr nightshift.

Up Vote Up Vote ×
Specializes in Complex pedi to LTC/SA & now a manager.
I think I got mixed up.

Someone suggested letting mom pour the total volume needed for the 8 hr nightshift.

It's possible in a brand new bag with commercially prepared formula but not if powder mix or if anything is added such as water, salt

Up Vote Up Vote ×
+ Add a Comment