School Nurse Incident in Orlando. What Would You Have Done? - Page 7

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  1. May 29, '12 by
    Quote from Esme12
    In the schools,thedisensing of and prescribing of medications does not mean that they can be administered by the school nursing staff.
    I don't think I ever claimed they could. What I was referring to was that the lack of parental permission to carry the med at school did not imply that the parent had not consented to the child taking the medication in any setting, that is a different process.

    Quote from Esme12
    Many of these inhalers need to be "tracked" for they are abused as a prime med to engage in huffing with his friends.
    In Volusia county schools, where this occurred, students are allowed to carry MDI's without it being "tracked", with parental permission.

    Quote from Esme12
    I find it interesting that a cyanotic asthmatic was revived by a puff off an inhaler and even more interesting that the mother called a lawyer (Casey Anthony's parents lawyer)and not 911 OR take her critically ignored son to the ED. At the school I subbed in...without parental consent meds aren't given and the parent or 911 s called. The followed their protocols and called the parent.
    I certainly won't argue that the story is fishy and the mother is milking the opportunity, although I'm not sure that really matters in practical terms. I've had many a patient who I'm skeptical of their complaints of pain, I don't see any convincing clinical signs of pain, yet if I say I'm not going to do anything because I don't believe them I don't think I should be too surprised if that gets me in trouble, regardless of whether or not I was right.
    While they did call the parent, the parent claims to have directed them to call 911. There policy is actually to call 911 and the parent in any potentially emergent situation, it's not one or the other.

    Quote from Esme12
    In the system I sub.....the child will not be allowed to return to school without the proper permission for the administration of the meds....to ensure the safety of the child. They stay home until the proper authorizations is signed. Emergent treatment guidelines/permission as in a ED setting do not apply.
    Seems totally reasonable, and could have preventing this whole scene, particularly if the district had followed it's own policy which is to review these authorizations every 3 months which would have shown that his previous authorization was out of date.
    Last edit by MunoRN on May 29, '12
  2. May 29, '12 by
    Quote from munorn
    parental informed consent for treatment occurs when the medication is prescribed and dispensed, which has already occurred.
    this statement may apply to the family setting, but not to non-family members paid to provide care to minor children in the outpatient setting. i strongly encourage you to read your npa regulations on administration of medications by nurses and non-licensed peronnel in the school setting. unless your state deviates significantly from the national norms, this statement is simply not true. parental informed consent for the administration of medication in the school setting (self or by an adult) occurs when written authorization is received.

    i actually don't think school nurses are either lazy or irresponsible, in fact i think they are severely overworked and under-supported. what i don't agree with is that the parent is solely responsible for the blame that the formed wasn't filled out because, as you pointed out, many of them are irresponsible and lazy. while many are, it doesn't absolve staff from making sure everything is in place to be able to act on the student's plan of care. at some point i agree, there is little left to be done to achieve compliance, although in this case there doesn't appear to have been any attempts made.

    please cite evidence from articles or interviews to support this.
    wooh likes this.
  3. Asst. Admin
    May 29, '12 by
    Muno....I hear what you are saying, but really we don't know the details. I am all for playing the devils advocate so that all aspects about any given situation are explored.

    We just don't have enough information. Did the Mom REALLY say to call 911? As Jolie has pointed out school nursing is a very different animal. I'm an ER nurse.I am all over the parental consent requirements. I was surprised at the do's and don'ts of school nursing.

    As Jolie has pointed out very eloquently, several times.........It really is a speciality all of it's own.
    Jolie, Purple_Scrubs, and wooh like this.
  4. May 30, '12 by
    Quote from Jolie
    This statement may apply to the family setting, but not to non-family members paid to provide care to minor children in the outpatient setting. I strongly encourage you to read your NPA regulations on administration of medications by nurses and non-licensed peronnel in the school setting. Unless your state deviates significantly from the national norms, this statement is simply not true. Parental informed consent for the administration of medication in the school setting (self or by an adult) occurs when written authorization is received.


    I would agree with you in the case of administering medications, however the situation here involves self-administration, which the NPA's I've looked at so far all define as being very different from administering medications. There is no inform consent involved in self-administration of "patient's own" medications other than that which occurred when the medication was prescribed, which is why so many people not qualified to obtain informed consent/administer meds can provide people with their medications for the purpose of self-administration.

    NPA's are also very clear on what informed consent is, and "written authorization" by itself is not informed consent. Informed consent is informed consent, authorization is authorization. If we were talking about giving a student a med that was not already prescribed for them and used by them, then yes informed consent would be needed.

    Quote from Jolie
    Please cite evidence from articles or interviews to support this.
    I don't think we know that, which is why I said they didn't "appear" to have followed their own policy of reviewing authorizations, nor did it "appear" that they attempted to resolve the problem prior to this, here's why. Their policy is to review authorizations every 3 months, this would mean that one should have occurred by at least November, that would have shown a student with a previous authorization did not have a current authorization, even though it's unlikely his asthma has miraculously resolved over the summer. If this did occur, the only way they would have let the child continue to attend school with his inhaler for another 5 and a half months would be if they weren't all that strict about the policy, which is obviously not the case, so that leaves us with one likely possibility; they were unaware they lacked an authorization form until the MDI was found.
  5. May 30, '12 by
    Quote from MunoRN
    [/B][/I]I would agree with you in the case of administering medications, however the situation here involves self-administration,
    Which we've had at least two school nurses tell us that they need written authorization for that. If kids could just self-administer without a consent, the inhaler wouldn't have been taken away in the first place. I would think if anyone on this thread would know the actual legal requirements of school nursing, it would be the two school nurses.

    Think of it this way: It doesn't matter that the NPA allows us to do something if our employer's P&P doesn't allow it. We've got to go by the stricter rules.

    Not to mention, handing it to the patient for them to squeeze is still administration. When I give an adult their medicine, I usually don't put it directly in their mouth, I put it in their hand, then they "self administer." but I'm still liable for administering the wrong med if I threw in their hand a percocet instead of their ordered tylenol #3. I can't go and claim, "But she self administered it! I didn't put it in her mouth!"
    If I hand someone the inhaler, I've administered it. Doesn't matter that they do the squeezing.
    mc3, sharpeimom, Jolie, and 1 other like this.
  6. May 30, '12 by
    I don't think there is any more to be discussed without going round and round in circles. I strongly encourage Muno and everyone to familiarize themselves with their state laws regarding medication in school as well as their own kids' school policies.

    If meds (RX or OTC) are truly being distributed willy nilly to kids who bring in a supply, without prior written parental authorization, by lay staff without significant training, then there are problems far worse than a Drama King with an unauthorized inhaler and his mother.

    Thanks for the conversation!
    mc3, Purple_Scrubs, wooh, and 1 other like this.
  7. Guide
    May 30, '12 by
    Quote from unleish05
    ...not standing there waiting for the cows to come home...smh !!! I'd probably sue the school if i had a child in that situation.
    Random, but what is "smh"?
  8. Asst. Admin
    May 30, '12 by
    Quote from sapphire18
    Random, but what is "smh"?
    According to the online urban dictionary smh= "shaking my head"
    sapphire18 likes this.
  9. May 30, '12 by
    Quote from wooh
    Which we've had at least two school nurses tell us that they need written authorization for that. If kids could just self-administer without a consent, the inhaler wouldn't have been taken away in the first place. I would think if anyone on this thread would know the actual legal requirements of school nursing, it would be the two school nurses.

    Think of it this way: It doesn't matter that the NPA allows us to do something if our employer's P&P doesn't allow it. We've got to go by the stricter rules.

    Not to mention, handing it to the patient for them to squeeze is still administration. When I give an adult their medicine, I usually don't put it directly in their mouth, I put it in their hand, then they "self administer." but I'm still liable for administering the wrong med if I threw in their hand a percocet instead of their ordered tylenol #3. I can't go and claim, "But she self administered it! I didn't put it in her mouth!"
    If I hand someone the inhaler, I've administered it. Doesn't matter that they do the squeezing.
    Authorization is required, I've never said otherwise, it's the difference between "administration" (which involves informed consent), and self-administration (which involves authorization) that defines who's legally at risk by returning this kid's inhaler to him and whether or not there's any truth to the argument that Nurse and school could not have returned his inhaler to him without breaking the law.

    In a situation where the Nurse is "administering" an MDI, the Nurse and the school is legally responsible and therefore at risk, as opposed to returning the student's own inhaler to him (which he is legally allowed to possess and use off of campus) with the requirement he not use it on campus without authorization or be removed from campus. If he uses it on campus without authorization then he is breaking the policy and law, not the Nurse or the school, although it's been argued otherwise. It would seem the obvious choice would have been to remove him and his inhaler off of campus until he obtained authorization. Separating an asthmatic kid from his inhaler, particularly one prone to apparent hissy fits, seems like the worst possible choice, and was not required to keep the Nurse or the school in safe legal waters.

    Handing a person an inhaler can be part of either administering or self-administering. Every state defines and difference between the two and "administering" is defined along these general lines: Administering is the act of interpreting a Physician's order; assessing for the appropriateness of the medication; informed consent (assessing the patient's knowledge of the purpose, effects, adverse effects, etc of the medication); confirming the rights of med administration, giving the med (which may include the patient themselves physically putting the med into themselves), and assessing the patient for effectiveness, adverse effects, etc.

    Assisting with self-administration is simply handing them their inhaler. Both involve handing someone an inhaler, although as you can see these are two very different things.

    It's not all that common in the hospital, but is not unusual in outpatient and observation patients where patients do sometimes get orders allowing them to self-administer their own meds, mainly because medicare doesn't cover "administered" medications in these types of patients. If a patient with an order to self-administer their own puffer asks you to get it out of their bag and hand it to them, you are not administering the med, which is why it doesn't matter if the Nurse or the housekeeper hands them their puffer, neither one is "administering" the med. This difference is also how many schools get away without having a Nurse. At my wife's school, there are kids who use puffers prn. When they need a treatment, they go to the office where the school secretary hands them their puffer. The secretary has no legal ability or training to "administer" medications, which is fine since she isn't administering.
    Last edit by MunoRN on May 30, '12
  10. May 31, '12 by
    I was interested to see what AN thought of this situation. I watched the report on the news and told my husband the school nurse was in a no win situation. Either decision had serious repurcussions.
    Give the inhaler or not give the inhaler. I'm glad I am not that nurse.