Something for all you school nurses... Something for all you school nurses... - pg.2 | allnurses

Something for all you school nurses... - page 2

First off, I am not a nurse. I am a caregiver for a diabetic relative who has mobility issues due to a stroke. I am also a teacher assistant for a first grade class in a school that has a large... Read More

  1. Visit  Songbird,RN profile page
    #13 1
    I am a school nurse. In our district, in order for a student to carry an inhaler, the doctor has to sign he gives permission to carry the inhaler, and in addition, he must sign he taught the student how and when to use it! The parent and the student then must sign also. I would NEVER accept ANY kind of medication for a student at school without the PROPER documentation. In not doing so, I don't always make friends. Oh well, not only are the students protected, but so am I, and so is my school district. I am appreciative of the parents who will have the student carry an inhaler AND keep one in my office also.
  2. Visit  caregiver1977 profile page
    #14 1
    Not only could you lose your license, but if what if another child takes the medication that some student brought (like in this case) and the child gets sick, has an allergic reaction, dies, etc.? That would be horrible, and that could have happened at my school yesterday!
  3. Visit  caregiver1977 profile page
    #15 0
    Quote from RFarleyRN
    I am a school nurse. In our district, in order for a student to carry an inhaler, the doctor has to sign he gives permission to carry the inhaler, and in addition, he must sign he taught the student how and when to use it! The parent and the student then must sign also. I would NEVER accept ANY kind of medication for a student at school without the PROPER documentation. In not doing so, I don't always make friends. Oh well, not only are the students protected, but so am I, and so is my school district. I am appreciative of the parents who will have the student carry an inhaler AND keep one in my office also.
    I have never had to do this for any of my children. Is it so hard to get proper documentation. Couldn't that be done in the doctor's office when the doctor is prescribing the medication?
  4. Visit  traumaRUs profile page
    #16 0
    Merged both threads.
  5. Visit  Jolie profile page
    #17 7
    Quote from loriangel14
    Keeping it in the office would not be acceptable. If a child has an asthma attack they need it right away.Time spent going to get it, unlock a door or a drawer could be the difference between life or death. A young man died in my area because he had left his in his locker.By the time someone managed to get it he was gone.
    But I do agree that he proper documentation should be followed.
    I understand that you intend to advocate for the student by insisting that the inhaler be kept on her person.

    But an inhaler is not only useless, it is potentially very dangerous, in the hands of a child too young and immature to understand its use and safe handling, as is obviously the case with this first grader.

    I can assure you that a typical first grader would be incapable of promptly identifying and responding independently to the early s/s of an asthma attack. This is a level of skill and awareness that is not usually reached until about the age of 10 - 12.

    Younger children are far better served by having medications in the safekeeping of a responsible adult (nurse, teacher, health assistant, etc.) who is well trained in identifying the need for, and proper use of, an inhaler, Epi-pen, or other emergency medications.

    This is also important for the safety and well-being of classmates and the protection of the school district from liability.
  6. Visit  Spidey's mom profile page
    #18 4
    Quote from caregiver1977
    Question: can't you get the proper documentation at the time the medication is prescribed (I don't know, never had to do this for any of my children)?
    I took stacks of Medical Authorization forms to all the local physician's offices so they could WRITE IT AS THEY PRESCRIBED THE MEDICATION!!

    Sheesh . . . .seems so simple to me.

    However, I still have to follow-up on many of the meds by calling parents. Seems like the physician's offices would like to streamline this.

    I have a new Kindergarten student who will be starting next Fall - at Kindergarten registration his mom wrote he was allergic to bee stings. When I called her to ask for more details, she said they gave him Benadryl. I told her I needed a physician's order for even Benadryl and she should ask about an epi-pen as well. He's been bit 3 times and each time was worse . . .

    Follow the rules or it will bite you in the tush.
  7. Visit  NutmeggeRN profile page
    #19 4
    frustrating scenario....i work with hs kids and i am sure there are those who are carrying an inhaler that have no paperwork.(despite letters home, in the newspaper, in the handbook etc that every parent signs...)


    if i am given an mdi (or knowledge of the student having one), the first thing i do is get parent permission form signed and fax it to the pcp....and part of that form is the pcp signing off along with the parent, the child is able to carry and self administer.

    however, as noted in other threads, the school nurses are sometimes the last to know of a situation.....

    .when i do have the mdi i make sure it is labeled (both canister and plastic holder) with name.

    in an ideal world a little light bulb would go off when the pcp determines the need for meds at school

    the pcp writes an order
    the parent asks for a copy of the prescription order
    the child is instructed on proper use and demonstrates that knowlwedge
    both parent and pcp sign the form acknowledging such
    the parent delivers the medication to school as written in the handbook
    parent signs the school form
    the parent stays long enough to fill out and discuss the asthma action plan so that it can be sent to the pcp for review and signature
    the child then goes off the class with the process all done appropriatley and they are ready to help themselves in the event of an asthma attack

    sadly,we do not live in an ideal world......
    Last edit by NutmeggeRN on May 16, '12
  8. Visit  caregiver1977 profile page
    #20 1
    Quote from Jolie
    I understand that you intend to advocate for the student by insisting that the inhaler be kept on her person.

    But an inhaler is not only useless, it is potentially very dangerous, in the hands of a child too young and immature to understand its use and safe handling, as is obviously the case with this first grader.

    I can assure you that a typical first grader would be incapable of promptly identifying and responding independently to the early s/s of an asthma attack. This is a level of skill and awareness that is not usually reached until about the age of 10 - 12.

    Younger children are far better served by having medications in the safekeeping of a responsible adult (nurse, teacher, health assistant, etc.) who is well trained in identifying the need for, and proper use of, an inhaler, Epi-pen, or other emergency medications.

    This is also important for the safety and well-being of classmates and the protection of the school district from liability.
    Couldn't have said it better myself.
  9. Visit  mc3 profile page
    #21 1
    Oh my, what a mess. Our policy is very clear on this, thankfully. If the inhaler comes with the box that has the Rx label on it, that label is considered an MD order and a parent can bring it in as long they sign consent for us to give. The box and inhaler are kept in the clinic. If the doctor (not the mother) indicates on a written form - either RX or on the medication consent form that child has been trained and is fully capable of managing their inhaler, they are allowed to keep it. If not, it must be kept in the nurses office. No question. If this child has an asthma attack, I can be called to wherever they are and be there in under a minute to administer med. That is what I'm there for. If any questions, 911 is called. No exceptions. Do you know what that medication could have done to one of the other kids? We had a situation like that (not our school) a long time ago, and the child's parents and school were sued. It was not pretty.
    No way, no how would I have allowed that. I think the RN was being irresponsible and not looking at the bigger picture.
    Just my 2 cents worth....
    mc3
  10. Visit  caregiver1977 profile page
    #22 0
    Quote from mc3
    Oh my, what a mess. Our policy is very clear on this, thankfully. If the inhaler comes with the box that has the Rx label on it, that label is considered an MD order and a parent can bring it in as long they sign consent for us to give. The box and inhaler are kept in the clinic. If the doctor (not the mother) indicates on a written form - either RX or on the medication consent form that child has been trained and is fully capable of managing their inhaler, they are allowed to keep it. If not, it must be kept in the nurses office. No question. If this child has an asthma attack, I can be called to wherever they are and be there in under a minute to administer med. That is what I'm there for. If any questions, 911 is called. No exceptions. Do you know what that medication could have done to one of the other kids? We had a situation like that (not our school) a long time ago, and the child's parents and school were sued. It was not pretty.
    No way, no how would I have allowed that. I think the RN was being irresponsible and not looking at the bigger picture.
    Just my 2 cents worth....
    mc3
    Our RN here is not full-time at this school. She shares her time at other schools. I don't know who would give the medication if she is not here and a student needs it. I am sure there is a plan, it is just that I don't know it.
  11. Visit  lilcece363 profile page
    #23 4
    I would not have taken the inhaler without documentation from the doctor. If the asthma is that bad to need it at school right away, sorry but you need to keep the child home and bring me back the appropriate paper work.
  12. Visit  bleemadden profile page
    #24 1
    I had a run-in with a parent at the beginning of the school year wanting to drop off an inhaler. Although the inhaler had the prescription on the box, we can't accept any without a physician filled out and signed Asthma Action Plan. The family had just moved from out of state and hadn't gotten a local pediatrician yet so the form couldn't be signed. After a long battle over district policies, I refused to carry on and simply stated that I don't write the rules, I just enforce them. I gave her the blank Action Plan and let her know that I was glad to take the inhaler when she has a pediatrian sign it and she huffed out of my office. A couple of days later the teacher found the inhaler in the girl's backpack which is against multiple policies with the district and our school (we are only K-2..too young to be carrying their own meds). I once again had to address the mom who was not happy. They've now been in town for a month and a half which I feel has been more than enough time to find a pediatrician...we are a small town and only have a couple of pediatric practices...so I've ran out of sympathy. The girl's backpack gets checked everyday with no inhaler being found, and the mom has failed to contact me further.
    We never want anything bad to happen to the students, but if anything did, it's on mom now. She knows our policies and was given the Asthma Action Plan and has now had more than enough time to find a pediatrician. It's so sad but with our school getting sited for taking meds without that sheet last year and me being a new health aide this year, I have been very carefully crossing all of my T's and dotting my I's.
  13. Visit  Artistyc1 profile page
    #25 0
    Quote from loriangel14
    Keeping it in the office would not be acceptable. If a child has an asthma attack they need it right away.Time spent going to get it, unlock a door or a drawer could be the difference between life or death. A young man died in my area because he had left his in his locker.By the time someone managed to get it he was gone.
    But I do agree that he proper documentation should be followed.
    When dealing with a 1st grade student, we do NOT let them carry, it IS kept in my office. If an asthmatic child is complaining of respiratory symptoms, they would be escorted down to my office by a teacher or another student. If doing that poorly, the classroom would call me in my office and have me bring it, but if they were that bad, I would probably need to call 911, anyway.
    There is not much information given regarding the boy that died in your area from "his inhaler being in his locker". The boy probably would have had other things going on, such as bronchitis or other respiratory infection, or perhaps exposure to an asthma trigger, thus exacerbating his asthma. Also, there obviously was a problem with staff not recognizing his distress and not calling 911 in time to save him. This is what asthma action plans are for!

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