Curious about how to handle this situation.. - page 3

I'm a student nurse and this is just a "what would you do" question. My husband went to a church camp this weekend and was a cabin leader for 15 ten year olds. There is no formal med policy at... Read More

  1. by   chrisrn24
    This is not a HIPAA violation.

    If I am at work and someone I know comes in, I can't go home and tell my family "hey guess who was at work today?"

    If I'm at a medical clinic for a physical for myself, not on work property, not on a clock and I see someone I know I can go home and say "hey guess who I saw at the clinic? Mrs. Johnson down the street."

    OP is a student. This is in her own home. The only she is guilty of is being a snoop which is not a big deal!
  2. by   jadelpn
    Quote from 2bRNFarmer
    I'm a student nurse and this is just a "what would you do" question.

    My husband went to a church camp this weekend and was a cabin leader for 15 ten year olds. There is no formal med policy at this camp, it's pretty casual.

    A kid (who he didn't know) handed him a bag of meds with instructions from his mom and said "mom said to give this to the cabin leader". So dh took the meds and put them in his bag. He ended up coming home the second night and accidently brought the kid's meds home with him, before he left to take them back I looked and noticed what they were.

    2x zyrtec
    2x benadryl
    2x ibuprofen

    to be given each night. I told dh those were double the dose for a 10yo and I wouldn't give that kid those meds at those doses if I were him. I didn't attend the camp, but it got me wondering what would I do if I did? He just gave the meds to the cabin leader that replaced him.

    What are a "real nurse's" responsibilities at a casual event like this? Would you intervene or do you feel it's none of your business if you weren't the one supposed to give him his pills? Am I just a jumpy nursing student and there isn't anything wrong with the doses she sent? I'm very curious how you seasoned nurses would handle it.
    And just so you are aware, OP and your future nursing practice--

    1. IF a camp is "casual" and has no medical policy/procedure/guidelines, then in fact there should be no meds given at the camp.

    2. Medications are based on KG weight, and not age. So to say that the meds were "double the dose" is incorrect.

    3. Don't go searching for issues. In your future practice, it pays to be mindful--but not stirring a pot.
  3. by   Anna Flaxis
    So this camp has no medication administration policy and no medically trained personnel on site? This is a huge liability, and if I were your husband, I'd have nothing to do with it.

    Who is doing background checks on "cabin leaders" to make sure they're not sex offenders?

    As far as snooping into the medications, that was really none of your business. It's no different than snooping in someone's medicine cabinet when they have you over for dinner.

    It's too bad your husband had to drive the meds back, but that's just the way it goes sometimes.
    Last edit by Anna Flaxis on Sep 30, '13
  4. by   Ack_RN
    I volunteered at a summer camp last year, I'd say it was pretty "casual" too. Parents filled out a form when they dropped their kid off if any meds were to be given. Wasnt anything fancy, but gave us the when and why. They were all prescription, so that helped ease my mind!

    There was one insulin dependent diabetic.... that made me nervous to say the least!

    As for your situation, did the camp leader have a list of all the parent's phone numbers? I would have given her a call if I was the counselor for her child. Just double check. (Maybe not at 2300 though... probably give someone a heart attack!)
  5. by   MilliePieRN
    Thanks everyone for your thoughts. It has given me a lot to think about. I'm really not interested in ever going to camp myself or becoming involved in its policies or decisions (even though I see that more structure is needed). If dh goes back, I'll tell him I'd rather him not have anything to do with someone else's meds. Easy peasy.

    I was wrong to speculate on the appropriateness of those meds since I was not involved in the situation. Any further thoughts about it would just be guessing. My main question pertaining to what responsibility someone may have in dh's (or a nurse's) situation has been touched upon; not sure what liability someone would have, but it's better to not take the chance.

    Thanks for your thoughts
  6. by   Ruby Vee
    Quote from brownbook
    If I was not a nurse, just an adult along to supervise a church camp outing, I would call the mom and clarify the drugs, dose, when and why to give the meds. I would feel better if there were some one in charge I could refer to or some written policy about kids needing meds.

    As a nurse I would be even more concerned giving meds as my license would be "on the line." I would not go as a "nurse" unless it was clear to all parents, the church leaders, etc., that I was there as an adult helper/supervisor NOT as a nurse.

    The doses are probably fine for that child....but thank goodness for cell phones, just takes a phone call to confirm.
    Even if you were there NOT as a nurse but just as a helper, you are still a nurse. You could be held responsible for giving the kid too much medication.
  7. by   NutmeggeRN
    Quote from 2bRNFarmer
    So in a non-healthcare setting, with non-medical personnel, hipaa laws apply?
    Not HIPAA per the letter of the law but basic confidentiality.
  8. by   merlee
    I could understand looking at the meds to see if they were something that the child had to have that night, ie, antibiotics, something for an ongoing problem, etc. and needed to be returned right away.

    I was a camp nurse for a few summers; although HIPAA doesn't apply, there are some basic respect issues. We didn't advertise which kids were on ADD meds (although everyone seemed to know, anyway) or those that were on meds to help with bedwetting. But the kids usually told their friends, anyway.

    Every camp needs a basic med policy, and a form for parents to sign, same as the schools do. I have seen plenty of schools where the secretaries dole out the meds!

    But checking out the doses probably wasn't necessary.
  9. by   Esme12
    Quote from 2bRNFarmer
    I'm a student nurse and this is just a "what would you do" question.

    My husband went to a church camp this weekend and was a cabin leader for 15 ten year olds. There is no formal med policy at this camp, it's pretty casual.

    A kid (who he didn't know) handed him a bag of meds with instructions from his mom and said "mom said to give this to the cabin leader". So dh took the meds and put them in his bag. He ended up coming home the second night and accidently brought the kid's meds home with him, before he left to take them back I looked and noticed what they were.

    2x zyrtec
    2x benadryl
    2x ibuprofen

    to be given each night. I told dh those were double the dose for a 10yo and I wouldn't give that kid those meds at those doses if I were him. I didn't attend the camp, but it got me wondering what would I do if I did? He just gave the meds to the cabin leader that replaced him.

    What are a "real nurse's" responsibilities at a casual event like this? Would you intervene or do you feel it's none of your business if you weren't the one supposed to give him his pills? Am I just a jumpy nursing student and there isn't anything wrong with the doses she sent? I'm very curious how you seasoned nurses would handle it.
    Depending on the kids weight....Standard doses
    Ibuprofen is 5mg/kg
    Benadryl 1-2mg/kg
    Zyrtec 0.25mg/kg BID

    As a nurse, if I was the overnight Mom I would have the meds given by another camp counselor.....let the person in charge of the camp give the meds.
  10. by   Altra
    Quote from nhnursie
    Not HIPAA per the letter of the law but basic confidentiality.
    There are no "confidentiality" requirements imposed on the general public. The general public are free to share or not share, as they see fit.
  11. by   nurseprnRN
    Quote from ClearBlueOctoberSky
    What you did, looking to see if you knew the child, or the child's mother, would actually be a HIPAA violation. Even though it seemed like you had good enough intentions, it really is none of your business.

    Now, if you we're the camp nurse, you would look to see what the medications are and follow your nursing judgement and camp protocols, and confirm with the parent. At least, that is what I would do, but I'm not a camp nurse, so I really don't know what others would do in this situation.
    Pish-tosh, not a HIPAA violation. The mother essentially put these in the OP's husband's hands. Remember, you didn't seek this out and you didn't reveal it to anyone. People always forget that HIPAA violation doesn't occur if the patient/family tell you things; you can always listen to anything. Also, the OP and her husband are not a covered entity and did not obtain PHI from being in one.

    As to the management of medications at camp, I have a lot of experience with this in my capacity as a camp/camporee nurse in Scouting. We have medical forms which we require for any campout more than 72 hours in length that require a NP, MD, DP, or DC signature re health history, physical condition, and prescribed meds, and parental consent for treatment. These are kept in the health lodge by the camp nurse. Less than 72 hours, a form signed by the parents with health history and meds and the consent for treatment is required; these are normally kept in a binder by the unit leader or adult designate in case of emergency. All forms have insurance coverage information, name of PCP/pediatrician, and parent and alternate (grandma, auntie?) contact numbers (day, night, home, cell)

    As to who gives the meds, the Scouts are not hard and fast about that. Obviously things like epi-pens and inhalers, the kid carries and an extra is in the health lodge or with his/her leader. Any rx'd meds have to be in original containers with name, date, dose, prescriber on them; OTCs have to be in original containers with specifics written by MD or a parent as to when/how to give. Most long-term camps have the camp nurse give them at med times before meals and HS in the health lodge or at the dining hall. Note that since the Scouts are not in the primary business of giving or paying for health care, they are not a covered entity under HIPAA, and nor would your church group camp be. (We go by the Scout law-- a Scout is trustworthy, helpful, friendly, courteous, kind, and the rest-- to maintain a camper's privacy.)

    Some leaders feel comfortable giving OTCs as you describe, with written instructions from a parent. If not, they turf it off to the health lodge staff.

    I think you need to get your church group to think about a policy for meds. Many kids are on ADHD meds now, and the parents want to give them a "medication holiday" while they're at camp (in part because the parents don't want to deal with the kid at home on one), not thinking that attention and behavior expectations at camp are pretty much the same as at school, and a wild child at camp can get into a lot of trouble. Some kids take insulin, or have serious food allergies; some are on antiseizure meds. Your church camp committee can contact the local Scout council for advice from their camp nurses; AN has a Camp Nurse forum that can share resources, too.
  12. by   blondy2061h
    I was a camp nurse at a camp with strict medication policies several times. We always had an RN. We had standing orders from our medical director for OTC's. The parents were given a list of OTCs we had an checked off whether or not they were okay with their child getting them. If they were, would could given them based on weight (if under 80 pounds) or standard doses (over 80 pounds). Prescriptions had to be brought in original bottles with clear instructions. If the parents wanted OTCs outside of our standing orders they had to bring them in in their original bottles, labelled with the camper's name and dosing, with a signed MD note saying they wanted this given this way at camp.

    I have also participated in church retreats and such, but kids had to be old enough to handle their own meds appropriately there. These didn't allow participants until 6th grade, so it usually wasn't an issue.

    Once you're a nurse long enough you'll learn not to look for issues in the way you sort of did. Sometimes it's better just not to know.
  13. by   wooh
    I like how we've got people jumping to the conclusion that the camp is full of federal law violating sex offenders based on a single post.
    Not a HIPAA violation. Not even close.
    As a nurse, I don't give meds to other people. Someone else that won't take on any liability can do it. Even if they are reasonable dosages, which those likely are.

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