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Q: I have a question regarding medication
administration. The RN receives an order from the physician
to administer medication to an infant. One medication
comes only in capsule form, the other in an enteric-coated
pill. Because both meds are not available in a dosage
small enough for the infant, the nurse is asked on the
physician's order to cut the capsule three times, and
to cut the enteric-coated capsule in half. Of course,
the capsule is filled with medication in powder form
and the pill, which is not scored, is to be crushed
and mixed with formula. Is this legal?
- A.D.
A: There are no laws governing medication administration,
at least not applicable to this situation. This is a
matter for appropriate medication administration policy.
Whether this is occurring in the hospital or in the
home, a pharmacist should be consulted. If this medication
does not come in a form suitable for infants, my first
concern would be whether this medication was ever meant
to be administered to infants. If it is suitable for
infants, then the pharmacist should be able to mix it
in some form whereby an accurate dose could be administered.
In no event should the nurse ever attempt to administer
either of these medications as directed by the physician
in this scenario.
Q: As an RN supervisor in a Florida nursing home,
can I deem a situation medically futile to perform CPR
if the patient whom I was called to assess is not breathing,
has no pulse and is cool to the touch with obvious mottling?
- J.U.
A: Some states have enacted legislation that permits
a registered nurse to make a determination of death
in the long-term care setting. I can find no similar
legislation for Florida, however. Even in those states
that permit this nursing determination, the nurse must
follow specific policy written by the medical director
of the particular facility. The policy must define those
circumstances where death is appropriately determined
by the nurse.
Ask your medical director for the specific policy and/or
written protocol to cover the situation you described,
in which the resident's death appears to have occurred
more than a few moments ago.
Your best protection in these circumstances is, of
course, a do-not-resuscitate order, if that is in keeping
with the resident's advance directive. Florida law states
that a physician may make the determination not to resuscitate
and that nursing home personnel will not be liable for
following the order of the physician.
I read this to mean that absent a DNR, an RN must resuscitate
until told otherwise by the physician.
Q: I am a registered nurse and work in a community
hospital. I have had a difficult time in the last year.
It started when I felt compelled to report a physician
employee of the hospital to the corporate compliance
officer. I believed that the physician was charging
patients for services that were not provided. This matter
has been resolved, but since then it has been difficult
for me to work with the physician.
My problem now is that some weeks ago, he wrote
a letter to the physician medical director asking that
I be transferred from my present department. He went
on to say I often intimidated him, plotted against him,
was vindictive and put him in precarious situations.
He also said I have convinced the administration that
he has done something wrong.
This letter was brought to my attention by another
employee who found it on the fax machine. It had been
lying on an open fax for 24 hours. Several employees
within the department read the letter before it was
returned to him. He also faxed the letter to an employee
who works within the department to type for him.
I informed my manager of the letter, how it was
left on the fax and how I felt it was damaging to my
career and reputation. It was reported to higher management,
and all verbally agreed it was retaliation. I was not
given a reprimand nor counseling, and he was told only
not to do that again.
No other action was taken. I fear that he will continue
to write things that will damage my reputation, career,
chances for promotion and name. What is my recourse?
I need this behavior to stop. Please advise.
- R.M.
A: You need to contact an attorney in your state and
discuss this matter without further delay. The law of
defamation differs from state to state. Some states
require that you prove damages to maintain a lawsuit
for slander (speech) or libel (writings). Other states
impute damages when your professional reputation is
involved.
More important than a lawsuit, this behavior needs
to stop. A well-worded letter from an attorney to this
physician may make him see the error of his ways.
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