Reported for this?

Pediatric Critical Care Columnist · Nov 17, 2015

I guess I would fall under the "guilty-as-charged" heading in this scenario, although at present I work in a hospital. I routinely feed patients with formula I didn't prepare; we have a diet kitchen that prepares specialty formula and delivers it in milkshake containers to the floor daily. I have no idea if it actually contains what it says it does (other than by the smell). I also routinely feed patients with formula that another nurse has added electrolytes to, and EBM that has had Pregestimil concentrate added to it to increase protein and calories. These are labelled by the preparing nurse and double-checked and signed. Only feeds that have added electrolytes are documented on the MAR.

(Side note: We also administer meds - IV and oral - that have been prepared by someone else... our pharmacy supplies patient-specific individual doses of most antibiotics as well as mini-bags of small-volume infusions. I haven't watched them prepare these meds. Does that make me a negligent nurse?)

shark_nurse14, BSN, RN · Nov 17, 2015

I'm in pedi home care, and I will agree, there are grey areas...but NEVER when it comes to meds/formula/anything that you as a NURSE are administering to a precious little life. It is always your responsibility to make sure that the POC is being executed, that's why there is nursing in the home in the first place...general rule of thumb that I live by, if i didn't draw it/make it, I under no circumstance will give it. If mom wants to make the formula, great, tell her that if you are going to be the one administering it you have to watch her make it so you can be sure it's done right...she doesn't want you in the kitchen making it/watching her make it? You explain that in that case either she will be administering it and a supervisor will be told of what happened, or the child doesn't get anything. You always have options, and I'm sure you always have a supervisor/support staff you can call while on shift to ask. Ignorance is no excuse when it comes down to caring for a life.

allnurses Guide · Nov 18, 2015

about 45,including 3 past nursing supervisors.
She is getting nurses who have worked only 1 day on this case too.
From the "gossip" I am hearing,the regional administrator fired her.
She had only been working for 2 weeks.

Regardless, reporting 45 nurses working the case, and 3 past nursing supervisors to the BON is something I've never encountered or even read about so it will be interesting to see what happens here, if you want to PM anything about that you feel it's OK to share that would be great!

If the "grapevine" is correct and they obviously fired her after 2 weeks for (from her point of view) protecting the patient sounds like a potential powderkeg.

smartnurse1982 · Nov 18, 2015

I'm in pedi home care, and I will agree, there are grey areas...but NEVER when it comes to meds/formula/anything that you as a NURSE are administering to a precious little life. It is always your responsibility to make sure that the POC is being executed, that's why there is nursing in the home in the first place...general rule of thumb that I live by, if i didn't draw it/make it, I under no circumstance will give it. If mom wants to make the formula, great, tell her that if you are going to be the one administering it you have to watch her make it so you can be sure it's done right...she doesn't want you in the kitchen making it/watching her make it? You explain that in that case either she will be administering it and a supervisor will be told of what happened, or the child doesn't get anything. You always have options, and I'm sure you always have a supervisor/support staff you can call while on shift to ask. Ignorance is no excuse when it comes down to caring for a life.

First,I work nights. She makes formula during the day.

Also,the office is closed during the night.

Second,I thought it was ok because past nursing supervisors were ok with it as well.

let me ask this:

Do you refuse to give a feeding that another nurse made?

Do you refuse to use a can of Pediasure that another nurse opened?

JustBeachyNurse, LPN · Nov 18, 2015

Nights there is ALWAYS a clinical nurse manager on call and available. Are you sure past supervisors were ok with it or did they practice willful ignorance (don't ask/don't tell) which triggered down through the field nurses assuming it was acceptable practice?

I'm going to bet the BoN receiving 35 reports of nurses not following safe practices is going to trigger an investigation by the DoH into agency practices and possibly BoN into staff oversight and training. Once I saw DCF involved as possible medical neglect.

Did you make the best practice choice? No. You relied on erroneous information from others. You fell into the domino cascade so common in PDN. You won't ever make the same mistake again. Adding whole milk to a hypoallergenic formula is a big deal. That supervisor better had been on the phone to the prescribing provider to let him know instead of just trying to clean house of field nurses.

Before you sign any disciplinary actions read thoroughly.

shark_nurse14, BSN, RN · Nov 19, 2015

The office may be closed but I can assure you there is someone, most likely a supervisor, on call at times.

As for your questions:

Do you refuse to give a feeding that another nurse made? -If I didn't see it made, absolutely. There could be anything in it. ANYTHING. I don't care if it's a nurse/mom/PCA that made it. If you are the one administering it YOU are the one responsible for the aftermath. There are plenty of times I go to work and there's a full bottle (32 oz) of a liquid labeled "Elecare" made in the fridge. But, how am I to know what's really in that bottle unless I'm the one that made it? This doesn't mean I throw it out and waste it. I make my own to use on shift.

Do you refuse to use a can of Pediasure that another nurse opened?- When was it opened? Is it labeled? Did I see her open it? Where has it been since she opened it? If I walk on shift and there's an open can, I throw it out. If I walk on shift, and a feeds just being administered and I help the nurse I'm releasing out by pouring the feed that I just physically watched her open, yes I'll give it, because I'm 100% sure that it's what it's supposed to be. If I walk on shift and the nurse that's releasing me is just starting a feed and the bag is full of what she says is the correct formula, I request they sign off for administering that feed and not me because I don't know what's in the bag, and I didn't see how it was prepared. It's not a matter of who did what. Its the simple fact that you should never give something that you aren't 100% sure of what it is.

I'm sorry, but there's really no getting around the fact that a nurse is ever doing the right thing by giving something they can't say for sure what is (i.e. Would you give a med you didn't know? Would you look it up and do research or ask the patients mom and just believe her?...I know I'd do the former...)

smartnurse1982 · Nov 20, 2015

I cannot just make a separate feed for my shift.

Its impractical when a feed consists of 500ml peptamin,360 ml h2o, and 1/8 tsp lite salt given over 12 hours(just an example)

Also,insurance companies limit the amount of cans a pt gets.

They do not get unlimited cans. They get just what they need,nothing more.

Alex Egan, LPN, EMT-B · Nov 20, 2015

Exactly this. I'm glad everyone here works in a setting where they don't have to do this. But most of my cases are in a similar situation. It would be at best impractical and mostly impossible to not use formula made or opened by another nurse or the parents. This thread has been bothering me quite a bit because it makes me feel crazy for doing something that I have done routinely for the past six years. I have asked three clinical managers between two large agencys and all have agreed that using formula in this fashon is not really avoidable given how much formula is delivered each month. I don't buy the whole never using open containers or Meds prepped by other nurses. Don't you guys use multi use vials? Why there could be ANYTHING in there after another nurse uses it. Or a bottle of liquid medication, there could be ANYTHING in there If you didn't pick it up directly from the pharmacy. PDN is not a facility where everything comes unit dose and with the unlimited ability to get more supplies. This has been common practice in my areas for agencys that begin with B, M, and P.

smartnurse1982 · Nov 20, 2015

One post on pg 1 even admitted she uses formula made by other nurses......

poppycat, ADN, BSN · Nov 20, 2015

One statement made by the OP early in this thread pertaining to "best practices & standards" concerns me. OP stated that "they vary from agency to agency". Practice standards are spelled out in the nurse practice act & do not vary from one work setting or employer to another. When something happens that is reported to the BON, the nurse practice act is what the BON uses to determine whether the nurse followed practice standards.

smartnurse1982 · Nov 21, 2015

The office may be closed but I can assure you there is someone, most likely a supervisor, on call at times.
As for your questions:
Do you refuse to give a feeding that another nurse made? -If I didn't see it made, absolutely. There could be anything in it. ANYTHING. I don't care if it's a nurse/mom/PCA that made it. If you are the one administering it YOU are the one responsible for the aftermath. There are plenty of times I go to work and there's a full bottle (32 oz) of a liquid labeled "Elecare" made in the fridge. But, how am I to know what's really in that bottle unless I'm the one that made it? This doesn't mean I throw it out and waste it. I make my own to use on shift.
Do you refuse to use a can of Pediasure that another nurse opened?- When was it opened? Is it labeled? Did I see her open it? Where has it been since she opened it? If I walk on shift and there's an open can, I throw it out. If I walk on shift, and a feeds just being administered and I help the nurse I'm releasing out by pouring the feed that I just physically watched her open, yes I'll give it, because I'm 100% sure that it's what it's supposed to be. If I walk on shift and the nurse that's releasing me is just starting a feed and the bag is full of what she says is the correct formula, I request they sign off for administering that feed and not me because I don't know what's in the bag, and I didn't see how it was prepared. It's not a matter of who did what. Its the simple fact that you should never give something that you aren't 100% sure of what it is.
I'm sorry, but there's really no getting around the fact that a nurse is ever doing the right thing by giving something they can't say for sure what is (i.e. Would you give a med you didn't know? Would you look it up and do research or ask the patients mom and just believe her?...I know I'd do the former...)

So let me guess,you refuse to give PO feeds too?

They are usually made by someone else.(I assume you work PDN)

smartnurse1982 · Nov 21, 2015

I have an update.

The nursing supervisor for this case has been out since Tuesday.

Another nursing supervisor asked Mom again about the feeds and she denied it.

Mom demonstrated to that supervisor the correct way,so she didn't call the physician.