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This is a discussion on Assistive devices without an Rx/order in School Nursing, part of Nursing Specialties ... What's your school's practice when kids come in with too-large crutches, old orthopedic boots,...by JudithL_in_NH Jun 16, '12What's your school's practice when kids come in with too-large crutches, old orthopedic boots, braces, etc. --no MD visit-- that the parents want them to wear at school because "he sprained his ankle and I already had it at home and I'm not taking him to the doctor because I know what it is."
Under a previous administration, I was supported in requiring an MD note (discharge instructions from ED or urgent care), or no use of the equipment at school. (We do provide supervised use of a wheelchair --and a strong recommendation to take the child to urgent care--if a child truly can not weight bear comfortably)
Current administration worries that I'm too tough, and that it leads to dissatisfied consumers. I've been asked in future to review the item--and the child's use of it-- for safety, and if it appears safe the child should be allowed to use it. I have no training in assistive devices and do not wish to assume this liability.
What is your practice and would another professional—perhaps OT—be better suited to this “safety review”?
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- Jun 16, '12 by ixchelSo you'd have to officially sign off on something saying the device is safe for the child? I'm still in school, so forgive this question, but is it in the scope of practice to determine if non-prescribed treatments are safe? I'd say no, no, no and then no again. What if that kid really hurts themselves on their old boot or too-large crutches? Then parents come around saying, "but your nurse said it was safe!" Nope! It sucks because some parents might not have the money to go to the doctor, but seriously, what if what they are giving their kid is actually making the kid's injury worse?
- Jun 16, '12 by FlareMy school requires an order for crutches, wheelchair and so forth. Mostly because they need to be escorted by a hall monitor and need to coordinate use of the elevators, which are not open for free use in the school. I get my fair share of students that need to have their crutches adjusted - a great deal coming to me with devices fitted in ERs. As far as braces and surgiboots, i don't get too particular beyond calling the parent if there is no md order and letting them know that i am noting in the chart that the device was not advised by an md. If i feel that something is inappropriate in size, i let the parent know and use my prof judgement on whether or not it stays. Same goes for home wrap jobs on ace wraps - theyt are almost always wrapped incorrectly!
- Jun 17, '12 by rdsxfnrnIMHO, no note = no school. That doctor's note absolves you and the school of any liability if something happens to the student while on school property. Without it, you and the school are on the hook if anything happens. Not worth it.
- Jun 19, '12 by donnaceeIf they come in with an ace around the wrist or in a boot and expect me to excuse from gym, I ask them to get their parents on the phone immediaetly. I speak to parents and inform them that unless I have a dr's note, their gym period is considered an unprepared. use of crutches: again phone call stating unless the doctor provides me with a note, they are not allowed. I am not taing the responsibility if they fall and crack their head open. USUALLY after I say THAT the parents will either pick up for an ortho appt OR they ask the student to leave the crutches in my offcie and walk on their own.
- Jun 19, '12 by mortesomething i learned in my one week of camp nursing, those crutches can quickly become weapons. soo....no order, no crutches!