end of year sending meds home

Specialties School

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So, I am working as a PT school nurse right now, and I will be sending letters home next week about meds going home in June. I have a form letter left by the previous nurse (I am a permanent job sharing sub- NOT a CSN) and I am comfortable sending things like inhalers, Epi Pens, Ibuprofen, Celexa, etc., home with Bobby on the last day - not that any of them will show up to get them.

Here's my question: While I will not, under any circumstance send little Bobby home on the bus with 20 IR Ritalin/Adderal tabs (for him to sell, get stolen, crush and snort himself, whatever,) is it ok to send XR Ritalin home on the bus? I read that even if opened and crushed the beads in the XR capsules will not get one high. IDK if this is true (never tried it, ha!) but would you feel comfortable sending this med home with a kiddo? It is still a class 2 controlled substance, right?

Obviously if the kiddo/parent does not come in to claim it, I'm just going to throw it out with a witness anyway, but if he or she does stop in and want to take a controlled substance home on the last day, what should I do?

BTW, I cannot find a facility policy on this, even after asking the secretary (who legit knows EVERYTHING) or the principal.

Any guidance would be appreciated! Thanks!

As a mom, I expect medication to be returned to me at the end of the school year. My daughters' medication is $10. per pill and I would raise a big fuss if my money was just thrown into the trash.

As a nurse, I only take 5 pills to the school, to be used if my daughter forgets to take her medication before leaving the house. The school is not meant to be a catch-all for medicating kids!

Our school nurse sends a form at the end of the year, asking if we want the med sent home with the child, or if we will be picking up.

It is up to the parents to come in and pick up the meds. It is shocking how many parents become irate that the meds cannot be sent home with a child (even though it is explicitly stated in our handbook and on the state department of health website as well as receiving several notices).

It sounds like your daughter takes a once daily medication. Many students take a "booster" dose of ADHD medication at lunchtime. Some take their morning dose at school as well for a variety of reasons. The most common reason that i have heard is that a child may go to day care or a sitter's house before school and the parents do not want it given to early so that the medication does not wear off while the student still needs it to concentrate.

Do not send any controlled substance of any kind home with any child, not even once. Send the note to the parents, if they fail to pick up the meds, it's not longer your problem. Clarify and get a written policy from the district in how to dispose of unpicked up medications and then follow the policy. Sending controlled drugs home with minors on the school bus is an excellent way to endanger your license. There is simply no way to every justify doing this to the BON.

Our policy is that no controlled meds carried by students period. So if a parent doesn't pick them up they get disposed of. As far as the other meds we have a policy only a single dose carried by students. However, if a student has ibuprofen in the office, I wouldn't hesitate to send it home with the student at the end of the year but would still call the parent/guardian to let them know. I work in middle school so generally the kids are fairly mature. Of course I wouldn't do this for elementary kids.

our policy is a parent/responsible adult picks up the medication over the counter or prescription. I send home a letter mid may.

Most of the time- I do get parents to pick up. Other times they think leaving it during the summer is okay. My office staff that works in the summer have access to sign it out to parent. I do have on occasion left over meds come fall and I'm told to try and contact the parent before wasting it even though its our policy to waste if parent hasn't picked it up.. :rolleyes:

Specializes in ICU/community health/school nursing.

Sending the first batch of notes home today. No matter how much communication I do, there are always going to be parents who don't pick up medication. If the medication is RX and valuable maybe I try a little harder....but over the last five years I've learned that if I follow the policy I never get into trouble. Policy says we alert parent by mail, then put all the meds in a box and drive them over to the main office. Policy doesn't say I should keep them or send them home with a student, so I generally don't.

Thank you all so much for your replies! Sent all of my notes home today...now let's wait and see how many parents actually come to get their meds... I'm betting 5 out of the 27.

Update: Like I wrote, I sent my letters home yesterday, but I have concerns about what to actually do with the meds that don't get picked up. Don't want to flush them - the poor fish! And don't want to leave them in the trash or a sharps box (history of break ins.) So I called my local but not in the city (VERY trustworthy) police department (about 10 miles or a 45 minute drive during rush hour from the school) and asked about dropping them off. Every city has drug drop boxes, so that isn't a problem, but my question was - what if I were to happen to get pulled over with 18 different kiddos Adderall and Xanax in my backpack?

Spoke to the watch commander, who said that he had never had a question like this before. After some hemming and hawing, and discarding of good and bad solutions, he advised me to write a letter on district letterhead outlining what I was doing, have myself and 2 other people sign it, and call ahead to 911 and ask to speak to the municipality on call supervisor. Tell that person I am on my way with controlled drugs in my car. That way, he said, if i get pulled over (btw, I have not been pulled over in more than 10 years, but since I really appreciate both irony and my license...) they will have a record of my call, and know my intentions.

Realistically, he said that if I had an official RN badge and a good explanation, I would most likely be believed. However, he also said that it is within their reasonable guidelines to charge me with possession with intent to distribute. I'd rather not take the chance of meeting up with a city officer who is having a terrible, horrible, no good, very bad day and decides that I need to share the wealth.

This may seem like overkill to some of you, but I have been bitten hard by just doing what everyone else does in the past. I have no interest in being thrown under the bus (or police car) for a temp job that owes me no loyalty. I figure I can't go wrong by over planning/executing/documenting. Rather put too much effort into this now than spend too much time, energy and money in court later.

I'll let you guys know how it goes.

Specializes in IMC, school nursing.

I have often wondered that. Great forethought on your part.

We're never permitted to flush meds. They get dissolved in water, kitty litter or coffee grounds mixed in, sealed and disposed of in the trash. That is per our health department.

Specializes in NCSN.

Prior to our current procedure (Nurse and witness use a medication disposing box that the district orders), I was told that the nurse would provide a count of each medication and sign and send that document with the medications with the school officer who would then transport it to the station to be disposed of.

Specializes in med/surg, clinic, school.

Our school district policy allows children to carry only epi pens and inhalers on them so at the end of the school year that is the only medications that i send home with the children. I send a note to the parents a few weeks ahead of time letting them know what meds are at school and a date they will need picked up by and if not picked up they will be disposed of. I would never send any meds of any kind home with the students I envision them passing the Tylenol, Advil or allergy meds out to their friends on the bus and with that i could probably kiss my job good bye! Better to err on the side of caution.

Specializes in Surgery.
Well, now the board office is on a new kick to not send letters home to "go green" more so to save on postage.

I don't mean to sound obtuse, because I'm really not. Just a matter of lack of information more than anything, but I've read so many replies talking about snail-mailing paper letters home to parents, and it confuses me just a bit. The schools my children attended did that, but by the time they graduated high school, the general leaning was towards emailing parents with important information, providing that the parent had an actual email account. This being 1997 & 1999, the trend was definitely there, but the coverage wasn't. NOW, however, having been a substitute teacher for our local school system for a few years not that long ago, EVERYBODY, including the students, has at least one email account if not several. (I have four myself, and I'm now 60!)

Wouldn't it be very much more efficient to send these types of notices to a designated email account that the parent has indicated for ALL their school communication? I know you used to be able to set them up to indicate whether or not they had been read, but I don't mess with stuff like that anymore, because for me it's just not that important that I know that. It's certainly free, as opposed to mailing costs, no paper is involved, and a template can be devised much easier than making a paper form letter, which will just as likely hit the "File 13" when it hits the home mailbox.

As a former volunteer Clinic Assistant, in my kids' schools, which being part of an enormous underfunded urban system when they first started school, had NO nurse at all much more frequently than they DID have one. That was back when everything was done on paper, because there weren't other options yet in the mid-80's. But, since then, things have changed a great deal. Do they not allow you access to the email accounts, or is it a part of HIPPA of which I'm not aware to send such information over the email servers?

It just seems like such a simple solution, I feel like I must be missing something very basic here that I should know. I can't offer direct solutions, but I suppose that asking that question is permissable here.

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