Scope of Practice Question

[kjones1982, RN]

I have worked in a LTC facility as an RN for the last 14 years.  This LTC facility is a big company that owns many other places such as respite care centers and group homes.  I was asked this past Friday by the DON of my facility to give a Humira shot to a patient that lived at the respite care center.  She said the patients mother had forgotten to give it to her prior to dropping her off at respite care.  The DON stated the staff from the respite care center would be bringing the patient to my facility for me to administer the Humira shot.  I told the DON that I don't feel comfortable doing this because I know nothing about the patients medical history etc.  She stated that I was covered and able to do this because we are owned by the same company.   Is she right?

[Jedrnurse, BSN, RN]

Bad practice and bad precedent. (Not sure if it squeaks by legally, but I suspect not.) The PCP prescribing the Humira should put in an order for VNA or the like to visit for the shot, since the respite facility doesn't have licensed personnel.

On top of that, does an LTC nurse really need MORE things to be responsible for???

[Davey Do]

As long as there's a physician's order, the patient has a history of receiving the med, I don't see any problem administering an NSAID that is not a controlled med.

Just a one time help out thing.

[Jedrnurse, BSN, RN]

4 minutes ago, Davey Do said:

As long as there's a physician's order, the patient has a history of receiving the med, I don't see any problem administering an NSAID that is not a controlled med.

Just a one time help out thing.

Humira's a big-time immunosuppressant. I used to have to give it to a student every-other week. That stuff cost (at the time) $2000 a month!!

[NutmeggeRN, BSN]

On 11/4/2021 at 10:28 AM, Jedrnurse said:

Bad practice and bad precedent. (Not sure if it squeaks by legally, but I suspect not.) The PCP prescribing the Humira should put in an order for VNA or the like to visit for the shot, since the respite facility doesn't have licensed personnel.

On top of that, does an LTC nurse really need MORE things to be responsible for???

In the LTC facility I do per diem at, they are adamant about no cross over from units, due to how the regs are written for each level of care. If this is typically given at home, is it because the facility is not licensed for that level of care. And if there were an issue, you know they will protect the facility first.

[NRSKarenRN, BSN, RN]

The DON should be the respite facility "helper"  administering Humira to decrease any liability concerns using Respite patients own med which comes with order attached to med package.  

[JKL33]

This is more a matter of legalities, technicalities and liability than a scope of practice issue. An RN generally has the proper training to perform an injection and the training/knowledge to understand that checking for a valid order and assessing the basic patient situation is prudent.

It's one of those things that would be nice to be able to just do it without a bunch of hand-wringing as a favor/matter of convenience for the patient and daughter. But...that's too often not the world we live in. I agree it's goofy for the DON to not just take care of it if she's confident that becoming involved poses no problems.

[iluvivt, BSN, RN]

Tell the mother she needs to come back,bring the humara dose and give the injection herself. She at some point was trained to administer it,was deemed competent to do so and has delivery set up.This is what I would do 

[Been there,done that, ASN, RN]

On 11/4/2021 at 2:07 PM, NRSKarenRN said:

The DON should be the respite facility "helper"  administering Humira to decrease any liability concerns using Respite patients own med which comes with order attached to med package.  

I wonder if the DON knows how to give a SC injection.

[Been there,done that, ASN, RN]

It would be no problem, IF they provide you the chart. You could see the order and the history, then be comfortable administering the med. 

[dream'n, BSN, RN]

Seems like way too much of an issue for the dose to be given at your facility. You would need a new, one time order for the medication, have the medication available for the patient from your pharmacy, the patient's chart with PMH et all, and documentation of the last dose. I wouldn't trust anyone's word on the last date of administration and I would need it in writing or as part of the Dr. order. All of that seems ridiculous for you to have to do. Sounds like the mom needs to come give the medication herself. Plus I would not want to do this as I feel it might start a precedent of such things.

[NRSKarenRN, BSN, RN]

Persons reside in a RESPITE CARE CENTER when family on vacation, need a break, attending an event, etc.  Therefore, no family available to given Humara injection.

Facility is treated like an extension of patients home --no physicians orders needed, no skilled care provided ( home health agency often contacted for patients needing wound/skin care, post op care, medication instruction/administration etc.).   Staffing is usually personal care assistants as caregivers with a Resident Care Manager (often not a nurse) managing center. 

Thus, one time/monthly injection should be given by DON of affiliated SNF owned by same corporation if home care not requested --many HH agency's will not admit patient for a 1time injection.  Its totally OK for an RN to administer an injection based on RX attached/pharmacy instruction.