New to school nursing: need medication log advice.

[MaltyChick]

I have been a new school nurse for two months and there wasn't a nurse in this charter school before I started. The secretary or office personel were administering and documenting prescription medications. My problem is this: I noted an error in pill counts on two of my ADHD kids and updated the counts to reflect what was in the bottles and initialed the entires. The secretary then sent an email to me and the principal saying she noted I made changes, etc. and she wasn't happy. Today when I came in, the old completed medications logs are no longer in the Med binder and there are new logs. She has the pill counts being entered Before she gives the days dose, which means the number on the log does not reflect what is currently in the bottle!!!! Additionally, not one kid receiving school administered Meds had signed orders on file when I started. And when the child is low on adhd meds, she tells the kid to tell mom!!! He has adhd, he won't remember!!! Any advice or sample Med logs would be greatly appreciated!

[Flare, ASN, BSN]

I'd say that since you're the new sheriff in town that you take new inventory on all your meds (which it sounds like you've already done) and start fresh there. For all you know they may have been counted incorrectly from the start.

As far as med documentation goes - i personally do everything in my electric charting. But i do have a paper binder where i house all the orders for the year and keep blank grids incase i'm out (rare - but does occasionally happen) or in case the computerized charting goes down (also very very rare). I've attached my log for all to see, change, do whatever with. It works for me - may not work for you.

PRN med log.doc

[MrNurse(x2), ADN]

Welcome to school nursing. I started in a school with no prior nurse and it was challenging, but exciting. I also had issues, as they didn't even count meds and very rarely remembered to give them consistently. Being a charter school, you probably need to look into electronic charting. That is the only real way to protect the school and yourself. There are a few options out there that are affordable, but they all timestamp your entry and don't allow things like the missing logs to happen. Paper logs don't hold up in court as well as MAR's, as your old logs confirm the hazards, too easy to alter. That is a serious misstep and I would approach administration telling them you are trying to protect the school, covering up is MUCH worse than the actual miscount. Good luck and hopefully administration will understand that you are a valuable asset and listen to that which you were hired and trained for.

[MaltyChick]

Welcome to school nursing. I started in a school with no prior nurse and it was challenging, but exciting. I also had issues, as they didn't even count meds and very rarely remembered to give them consistently. Being a charter school, you probably need to look into electronic charting. That is the only real way to protect the school and yourself. There are a few options out there that are affordable, but they all timestamp your entry and don't allow things like the missing logs to happen. Paper logs don't hold up in court as well as MAR's, as your old logs confirm the hazards, too easy to alter. That is a serious misstep and I would approach administration telling them you are trying to protect the school, covering up is MUCH worse than the actual miscount. Good luck and hopefully administration will understand that you are a valuable asset and listen to that which you were hired and trained for.

Thank you for this great advice. I do think electronic documentation would be good for all nursing notes, however, for the medication documentation it may be challenging since my office is no where near the main office where the kpmeds are kept since I'm part time. Hmm. Thinking up new strategies! Which electronic data system or eMAR do you use?

[MrNurse(x2), ADN]

I am in the process of buying. SNAP offers subscription for our small school; approximately $300/year. They have add ons that are nice. In the broad scope of expenses, not too bad. You may want to see what program the educators use and see if there is a health plug in, we use Engrade and that isn't available. Keep away from any that claim they are free, they steal the info and spam parents. This forum saved me while I was starting out. Peruse the threads, they are informative and VERY funny.

[MaltyChick]

Welcome to school nursing. I started in a school with no prior nurse and it was challenging, but exciting. I also had issues, as they didn't even count meds and very rarely remembered to give them consistently. Being a charter school, you probably need to look into electronic charting. That is the only real way to protect the school and yourself. There are a few options out there that are affordable, but they all timestamp your entry and don't allow things like the missing logs to happen. Paper logs don't hold up in court as well as MAR's, as your old logs confirm the hazards, too easy to alter. That is a serious misstep and I would approach administration telling them you are trying to protect the school, covering up is MUCH worse than the actual miscount. Good luck and hopefully administration will understand that you are a valuable asset and listen to that which you were hired and trained for.

Thank you for this great advice and the med log. I do think electronic documentation would be good for all nursing notes, however, for the medication documentation it may be challenging since my office is no where near the main office where the meds are kept since I'm part time. Hmm. Thinking up new strategies! Which electronic data system or eMAR do you use?

[Rubor]

We use a medication calendar. It works well. I'm super stuck on what the secretary did...wow....that needs to be addressed.

[MaltyChick]

We use a medication calendar. It works well. I'm super stuck on what the secretary did...wow....that needs to be addressed.

thanks for the response. Yeah me too. I did have a conversation with her and the administrator and we are doing the Med counts my way- the right way. Interestingly, my walker talkie went missing from the reception desk where they charge it for me after hours. A few days later, the secretary suddenly had it. Hmmm. Passive aggressive much!??!! Luckily I don't need to deal with her too much.

[SchoolNurseTXstyle]

Admin needs to understand the legalities of medication administration and counts. Especially when you are talking about schedule 2 meds. Nobody should be changing any counts besides yourself and even then , you would need to have documentation to back it up!