Specializes in Peds/outpatient FP,derm,allergy/private duty.
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.
Just wanted to say I can relate to the feeling that certain situations in PDN would most likely have many nurses who haven't worked in this unique area aghast and even perhaps horrified. Having worked inpatient peds in the past I can understand why this happens. So many times in private duty with children and adults I find myself thinking "this is the most absurd situation I have ever been in" but yet it is definitely real life! Sometimes I shake my head a little to re-orient myself.
When you hit the road in a van with your patient (you haven't lived until your overconfident para-transit driver gets lost and suddenly you are in gangland central) it gets even weirder at times and a certain amount of flexibility is mandatory though we try to plan for all contingencies . . .stories, we've got them! I know I'm doing my best as I balance the conflicting aspects of our jobs.
They are usually made by someone else.(I assume you work PDN)
...I don't refuse to give PO feeds because my orders specifically say "foods as prepared by mom". But, I also didn't come here to validate what I do, or to get in a fight with anyone. I really truly hope that this works out for everyone involved, so often in PDN there are misunderstandings. I simply was trying to help and explain what I do to care for my patients in the PDN setting. Best of luck to you and the other nurses.
They are usually made by someone else.(I assume you work PDN)
...I don't refuse to give PO feeds because my orders specifically say "foods as prepared by mom". But, I also didn't come here to validate what I do, or to get in a fight with anyone. I really truly hope that this works out for everyone involved, so often in PDN there are misunderstandings. I simply was trying to help and explain what I do to care for my patients in the PDN setting. Best of luck to you and the other nurses.
If mom prepares the feeding,and you still give it,how is that different from what I am doing?
As I understand it,if mom prepared the feeding "the wrong way" and something happened after you fed him,you are still on the hook?
If mom prepares the feeding,and you still give it,how is that different from what I am doing?
As I understand it,if mom prepared the feeding "the wrong way" and something happened after you fed him,you are still on the hook?
You said in your original post that you have an order for "Elecare 10 scoops mixed with 1860 water."
Avery_shark says that s/he has an order for "foods as prepared by mom".
Both of you are legally and ethically obligated to follow the orders you have. In your case, you are legally obligated to be sure that what you are administering is 10 scoops of Elecare mixed with 1860 ml of water. Avery is (only) legally obligated to be sure that whatever s/he is giving the child was prepared by mom. That's the difference. In your situation, your choices are to either be sure that the formula is prepared per the order, or to get the order changed to reflect that the mother is mixing the formula, if that's what she insists on doing.
100 % agree with supervisor. Why would you administer something that someone else prepared? Doesn't matter if it is an oral medication, an injection or formula. I would never do it. You put your patient at risk and your license.
The one thing my teachers drilled into our minds as students: "Never ever take credit for giving something if you didn't prepare it or administer it yourself". Sorry but I'd have to agree with your new director. Your nursing license requires you to CYA. A note should have been written "patient's mother continues to insist on preparing and administering formula to patient. Teaching provided to mother that mixing formula with whole milk is contraindicated as formula is for milk allergy, mother verbalized/did not verbalize understanding..."
Specializes in Complex pedi to LTC/SA & now a manager.
The whole something you didn't draw up is one issue but if it's labeled appropriately (including unit does syringes prepared by pharmacy). There as provisions for using formula prepared by another or pre-drawn medications appropriately labeled (as may be drawn by the night nurse as the day shift nurse has 15 minutes to get everything ready before the bus arrives or patient single dose syringes prepared by pharmacy for PICU.). My agency has a specific policy for medications to be administered at school prepared by the previous shift. The same with parent prepared formulas except the 485 specifies PCG to prepare full batch of formula and refrigerate.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Speaking from my experiences since 2004 in PDN just generally, it is often not true that a supervisor is available 24/7, and rarely did I get a callback in under 1 hour. Since I had no vent training other than a 2 hour overview (which I attended after I had started working on the case) sponsored by a vendor who was also advertising his products and people are possibly shocked by that, not every agency does things according to the accepted standards of policy and procedure.
I cared more about my ability to take the vent cases more than they did. I had prior pediatric experience in inpatient, I studied online and went back for a second orientation (was paid for 2 hrs on just the 1st one) before my first day on my own.
The way people are describing their experiences with their agencies, all I can say is I only wish I had discovered such a place that had cases within reasonable proximity to my residence.
The agency will remove all feedings from the MAR and replace with feeding schedule sheets.
One supervisor at a different agency said feedings don't belong on the MAR.
She never explained why.
None of the inpatient settings in which I've worked over the years have ever had tube feedings on the MAR. Nutrition is not medication. However, just doing that still won't change the question of administering feedings when you don't know for a fact what the feedings contain. That would still be an error, and not carrying out the physician's order as written.
I dont think you should have been reported. Seems like a strange situation to be in with parents making the feed in the first place. Youre agency should support you and try to fix the situation and make all rules clear to all parties. You didn't do anything that harmed the patient or knowingly so anything wrong. Going to the BON seems inappropriate in this situation. Sorry about the bad luck. Id try to find an employer who wont turn on you, especially when youve taken a weird case to begin with.
nursel56
7,122 Posts
Just wanted to say I can relate to the feeling that certain situations in PDN would most likely have many nurses who haven't worked in this unique area aghast and even perhaps horrified. Having worked inpatient peds in the past I can understand why this happens. So many times in private duty with children and adults I find myself thinking "this is the most absurd situation I have ever been in" but yet it is definitely real life! Sometimes I shake my head a little to re-orient myself.
When you hit the road in a van with your patient (you haven't lived until your overconfident para-transit driver gets lost and suddenly you are in gangland central) it gets even weirder at times and a certain amount of flexibility is mandatory though we try to plan for all contingencies . . .stories, we've got them! I know I'm doing my best as I balance the conflicting aspects of our jobs.