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Discussion

Reported for this?

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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    • Featured Replies

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

    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.

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

    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?

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    • Experts
    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.

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    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.

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    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..."

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    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.

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    • Experts

    Does this really need to be reported to the BON?

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    • Guides

    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.

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    • Author
    Does this really need to be reported to the BON?

    According to posts on pg 1,its a med error,maybe through negligence.

    I think that she was just threatening us,because so far nobody has heard anything from the BON nor the nursing supervisor.

    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.

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    • Experts
    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.

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    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.

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    On 11/16/2015 at 1:42 PM, caliotter3 said:

    The time to discover what the deal was, happened when first told that Mom prepared the 'formula'. I never administer a med, a feeding, or a treatment that has been prepared by someone else. That is how I avoid problems such as this.

    I can tell you first hand parents will not let you make your own batches of formula when they have it ready in the fridge and have a limited supply that must be used within so many hours.

    I do not think the OP is at fault. In an ideal setting this would not have happened but home health is not an ideal setting. Parents go rogue all the time and they purposefully hide things from their nurses as well. They don't really understand that when we find out we could lose our licenses just over the fact we were not I formed.

    This really isn't fair.

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