School Nurse Incident in Orlando. What Would You Have Done? - page 8
I'm not a nurse yet, so I only know how I feel about this. What should this nurse have done? What would you have done? Nurse refuses student inhaler during asthma attack School says medical... Read More
May 30, '12 by JolieI 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!
May 30, '12 by sapphire18, BSN, RN GuideQuote from unleish05Random, but what is "smh"?...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.
May 30, '12 by JustBeachyNurseQuote from sapphire18According to the online urban dictionary smh= "shaking my head"Random, but what is "smh"?
May 30, '12 by MunoRNQuote from woohAuthorization 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.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.
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
May 31, '12 by imintroubleI 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.
Jul 28, '12 by pinkpinstripes, ADN, RNWhatever happened to "do no harm"! The boy had an inhaler that was current with his name on it and in his locker? It is a rescue inhaler, hello, give it to him and get the permission later from the parent. And he was noted to have asthma before, so he probably had signed consents for the previous 11 years? I would have called 911 so they could start the oxygen if there was none available and transport if needed, it's also called covering your arse! And this is why we get malpractice insurance.