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Our supervisor told us to spike and hang an antibiotic, but leave it for the certified nursing assistant to start. I am uncomfortable with this. Is this legal?

Wednesday November 21, 2012
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Question:

Dear Nancy,

Our supervisor told us to spike and hang the antibiotic, but leave it for the certified nursing assistant to start. I am uncomfortable with this, and we donít document it. Is this legal?

Paige



Nancy Brent replies:

Dear Paige,

The situation described in your question left out some important details. For example, what is your role at the facility? Are you an RN, an LPN or an unlicensed assistive worker? Although it is an age-old nursing rule in that one only administers medication that he or she draws up (or, in this case, "spikes and hangs"), if you are an LPN or an assistive worker, not only is that rule broken, but also this conduct is well outside your scope of practice. Some states allow LPNs to start IVs or add certain medications to IV solutions, while other states do not. Clearly, if you are an assistive worker, this should not be happening.

The absence of any documentation about your "spiking and hanging" of the IV bags is also very problematic. Who does the documentation? The CRNA? If so, he or she is falsifying the documentation about the IV, if they are stating they spiked the IV, hung it and started it.

From what you have described, this practice is legally risky at best. It also violates clear standards of practice of everyone involved, and does not conform with ethical nursing practice principles. Even if no patient is ever harmed by this process, it could raise issues with the board of nursing and the CRNA's ability to continue to practice at the facility.

To begin with, you may want to raise your concerns with the chief nursing officer of the operating room and/or the CNO of the hospital/facility. Or, you may want to contact a nurse attorney or attorney in your state who can advise you of the risks you face in participating in this practice and what you can do to rectify it (e.g., going to the board of nursing or other agency). To help you with this, you can visit the Association of periOperative Nurses' website at www.aorn.org. Click on the Clinical Practice tab and a drop down menu appears with topics such as Position Statements and FAQs. Also, the association offers a phone consultation service from 9 a.m.-1 p.m. (MST) on Tuesdays, Wednesdays and Thursdays. There is no cost for members, but there is a fee for non-members.

Cordially,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.