AM meds at school

OhioBPH · Apr 10, 2019

Does it require a physician order? What time is the order for? Here in my district I am not in the building until school has been in session for an hour. this cuts down on AM meds because there is no one to administer anything at the appropriate time. If the student is receiving it after the school day starts, are they getting therapeutic effect early enough? Or do they struggle for the 1st hour? Maybe express the need for more parent education about tricks to remember to give it before school.

JenTheSchoolRN, BSN, RN · Apr 10, 2019

Most ADHD meds need 30 minutes to be effective. Depending on when student arrives at school and when 1st class starts, giving it at school actually might not be the way for it to be most effective.

That being said, I've done it. WITH a doctor's order. I have a few students whose parents work nights and their child takes public transport to school and leaves before they arrive home from night shift. Giving it at school ensures student always takes it. I don't have an issue with this, but try to set it up with that 30 minute window in mind. My office opens at 7:30; class started at 8.

I don't do this with a lot of students - maybe 2-3 a year.

But what I've also done is (with a doctor's order) keep a back-up dose just in case a student forgets morning dose at home. This can set-up student to take at home, but cushion in case. Can that be a bridge with some of these students? What is the reason they take it as school vs home? Do they take it on the weekends? (some do, some don't) Summer? Breaks? If so, how is that managed?

OldDude · Apr 10, 2019

I've often tried to convince our teaching staff and administration to separate the association between school and home. Structure their academics where a kid can be successful at school with no participation from home. There would be no traditional homework but offer resources accessible by the parents to assist their children if they want to when the child was not at school. So, prefacing with this...I encourage anything that will help the child to be successful in school and I welcome the continuity of giving meds in the morning.

How many times have you called a parent because the kid didn't take their morning med and the parent blames it on the child for forgetting? Duh, why is the child taking the medicine in the first place? "attention deficit...?"

NurseMMJ · Apr 10, 2019

Yes, the meds do require a doctors order. Yes, most of the kids do struggle the first hour, and several teachers make comments regularly that the first hour is a wash with the students. That is a great point I can make in the future.

We currently have an outside social work agency that partners with the school and is housed in our building. They do satellite sessions with their doctor and seem to be able to get on order for meds at the drop of a hat.

I am in the building 15 min before our doors unlock for the students. So I am available for the students as soon as they make it to school.

JenTheSchoolRN, BSN, RN · Apr 10, 2019

9 minutes ago, NurseMMJ said:
Yes, the meds do require a doctors order. Yes, most of the kids do struggle the first hour, and several teachers make comments regularly that the first hour is a wash with the students. That is a great point I can make in the future.
We currently have an outside social work agency that partners with the school and is housed in our building. They do satellite sessions with their doctor and seem to be able to get on order for meds at the drop of a hat.
I am in the building 15 min before our doors unlock for the students. So I am available for the students as soon as they make it to school.

Then, really, morning dosing at school isn't feasible. I wonder grades look like for classes student takes in that first hour vs later. Can lost instruction time be minimized by medication being given at home? Not question for you, but to pose to others :).

How old are the kids? I work with older ones, so some medication taking responsibility can be on them and needs to be to help them properly transition to college where no one may be there in the morning to remind them. But elementary kids? Totally different.

Guests · Apr 10, 2019

I have had a few families try AM meds with me and I always try to talk them out of it and figure out why they can't do it at home. I have an AM Keppra and Depakote for a K student who goes to bed late ? and doses need to be 12 hours apart. I called the Neurologist and even she was like see if you can push mom to get him to bed ealier so he can get AM dose at home. Nope. So there't that one. And I have my T1D student's mom who is trying to tell us that he can arrive at school (via bus no less) on an empty stomach and do his BG check here, then eat, then get insulin at 8 am. NOPE NOPE NOPE!!! She "threatened" to get an MD order for this. I said "Good luck".

ruby_jane, BSN, RN · Apr 10, 2019

I was reminded today (in my impatience with a parent) that we need to do what is best for the student. Ironically it was a pre-K aide who reminded me. The counselors aren't necessarily being patriarchal.

In a perfect world, the parent would dose the kid 30 minutes before school. It's an imperfect world.

I have three kids who take both an AM dose and a noon dose in my Prek-7 school. We started the AM dose because I could see - literally - when they hadn't had medication in the AM.

I would prioritize seizure meds, diabetes care, and then ADHD meds in that order.

JenTheSchoolRN, BSN, RN · Apr 10, 2019

Just now, ruby_jane said:
I was reminded today (in my impatience with a parent) that we need to do what is best for the student. Ironically it was a pre-K aide who reminded me. The counselors aren't necessarily being patriarchal.
In a perfect world, the parent would dose the kid 30 minutes before school. It's an imperfect world.
I have three kids who take both an AM dose and a noon dose in my Prek-7 school. We started the AM dose because I could see - literally - when they hadn't had medication in the AM.
I would prioritize seizure meds, diabetes care, and then ADHD meds in that order.

Great point, ruby_jane.

I'll never say no as long as I have an order, which is why I think a back-up dose is a nice bridge to shared responsibility for parents/guardians and the school. If they don't get the med at all, well, that just stinks.

But I still wonder: weekends, school vacation, summers...how to manage and navigate that.

Guests · Apr 10, 2019

5 minutes ago, JenTheSchoolRN said:
But I still wonder: weekends, school vacation, summers...how to manage and navigate that.

I know our few ADHD kids here only take the meds on school days.

jess11RN · Apr 10, 2019

Do we work in the same school? Are you me???

Seriously, I could have posted this. I, too, have completely ran out of room in my locked cabinet and it is so frustrating.

Parents need to be parents, but bottom line, if me giving a pill in the morning decreases outbursts and keeps them in their seats learning, then so be it. I really try to avoid that circumstance, but when social work or admin brings up the idea, I feel stuck and have to go along with it. Luckily for me, that doesn't happen too much.

JenTheSchoolRN, BSN, RN · Apr 10, 2019

Just now, MHDNURSE said:
I know our few ADHD kids here only take the meds on school days.

Oh, I have students that do the same. And because of this, Mondays and especially Mondays after break aren't the best of days for a few.

Meds are only one piece of ADHD management, I know and preach this. But they do make a world of difference for a few kids that really benefit from them.