I am the director of nursing at a home healthcare company that provides mostly attendant care. We mostly use CNAs. My agency may get a client that requires medications every four to six hours and eye drops every two hours. The case manager has suggested that I train the patient’s wife to administer the meds while our aide provides attendant care. Since I will not be on site, what is my liability in doing that? This patient is comatose and will be going home from LTC on weekends.
Dear Nancy replies:
The purpose of home healthcare for any patient is to have the family as involved as possible in the care of the patient in order to lessen necessary visits to the home and have the family be as independent as it can be. As the director of nursing, there is no problem with you teaching the family/wife to administer the eye drops and medications. Patient and family teaching is a role that a nurse possesses in any healthcare setting, including home health.
It seems from your question that you do not have a home health nurse regularly visiting the home. He or she could certainly provide the instructions needed if this is something that a DON in your facility does not do or it is not in the job description.
Liability for you or the home health RN could occur if the patient teaching was negligent; that is, not up to the standard of care and practice of an RN in the same or similar circumstances in the same or similar community. The use of teaching forms and teaching checklists may help ensure that all that is needed to be taught is completed, including side effects of the medication, how the eye drops are to be administered and so forth.
Asking for a return demonstration after the teaching is completed would be essential as well. The documentation of the instructions to the wife would be essential.
Remember that one stint of teaching does not complete a nurse’s responsibilities in the home health setting. Feedback should be obtained from the CNA about his or her observations in the home and how the CNA thinks the patient and the wife are doing. You should also inform the wife that if she has any questions, she should contact you or the home health RN. Moreover, regularly scheduled visits to the home to see how the patient is doing and how the wife is handling her responsibilities would be important, as well.
You might want to consult with your agency’s legal adviser and obtain specific information required or needed by the facility if you or a home healthcare RN assumes this teaching role.