Changes this year

JoshuaAdamsRN · Jun 27, 2008

This is similar to the first camp I worked at, which was huge (~1200 campers per 12 day session). We had 1 RN, who had "office hours" during the day (like 8 am-5:30 pm), but then she was available by pager the rest of the time. The staff who worked in the health lodge was trained in Red Cross standard first aid, but there were also three EMTs.

The medication situation makes me kind of nervous, even though both camps I worked at did this. There's a limitless potential for mix-ups if you're not meticulous.

BonnieSc · Jun 28, 2008

What is the reason for the change in PM med administration? I think that's a huge mistake. The only time our counselors administer meds is when they're out on trips, and even when I have carefully trained them in med administration, mistakes occur. I'm also concerned about the meds being unlocked during that time. And surely there are some meds that need to be administered in the health center! And what about liquids? This sounds to me like a change that's being made for a minor convenience to the counselors. I fully believe the health center should work around camp, not vice versa, but not when safety is involved to such a great extent. There's no question about this in my mind: it's wrong, wrong, wrong. Counselors are not equipped to administer medications. I very occasionally send one out for special reasons: if the kid is already in bed and getting them up would be too hard on her, for instance. When I was a counselor I had a kids a couple of times who needed their medication immediately on waking, and I kept one dose at a time with me and gave it in the unit. But multiple medications? Every night? WAY too much room for error! I have serious doubts about this camp director's understanding of risk management, to be honest.

I also like to SEE my kids who take daily medications, no matter what for. Allergy pills? Gotta assess how they're working. Anti-depressants? How's the kid feeling? Pain medication? Is it effective? etc.

As far as the nursing assistant situation goes--the impact for your licensure depends on your supervisory responsibilities and so on. I can see why this makes you uncomfortable, but to be honest, this is the reality for many camps--in fact, many camps don't have a nurse on duty at all, ever, because they are so difficult to find.

Train them extremely well in the five rights, and make very clear what kind of documentation they need to do. Make sure they understand the situations in which you absolutely want to be called for a consult. Don't personally delegate anything you don't feel comfortable with, with the understanding that the camp director might "delegate" some of those duties.

Good luck, and please let us know how it goes. I would put my foot down about that med administration policy--perhaps it would help to come up with ways to make evening med administration more convenient, while keeping it under your direct watch (or that of your trained assistants).

Miriam57RN · Jun 28, 2008

What is the reason for the change in PM med administration? I think that's a huge mistake. The only time our counselors administer meds is when they're out on trips, and even when I have carefully trained them in med administration, mistakes occur.

Long waits - inconvenient for the campers/ counselors. They'd all descend at once upon the HC, many groups at a time - this meant even those kids who weren't on meds had to wait. Thing is, this is also when many campers and counselors would bring up their physical c/o's. This naturally increased the wait time.

We had a meeting with the Director yesterday and brought up our concerns. I said I was going to administer the meds at the cabins the first couple of nights so I could at least meet these children, assess as needed, and train the unit leaders. I could tell he thought I was going overboard, that he thought it wasn't necessary. 'What's to giving a kid a pill?' Surely he has no appreciation for the implications involved. My sense is that the Dir. and Assoc. Dir. think all we're necessary for is med preparation. Get everyone trained in Wilderness F. A. and off we go.

I'm very uneasy about this new plan to say the least, and it showed in my BP. I had the NA's practicing on me and we got 160/96 with repeats.

He also moved our bed out of the HC. Now only the two NA's will be there overnight. I do have the prerogative to stay overnight when I feel it is necessary, but will be in another building.

I'm also concerned about the meds being unlocked during that time.

I am also - have said I want them locked (except for epi twin pack and benadryl).

And surely there are some meds that need to be administered in the health center!

Yes, some kids will have to be brought to us.

And what about liquids?

Capped oral syringes that will be labeled and poured into med cups when given. I'll have to show them to wash out the med cup with water so the child gets whole dose, etc. The unit leaders will have to return the oral syringes to the HC (hope its not too inconvenient for them!) as we don't have an unlimited supply of these. They'll be labeled so I'll wash and use the same oral syringe for the child each night, as in home care.

This sounds to me like a change that's being made for a minor convenience to the counselors. I fully believe the health center should work around camp, not vice versa, but not when safety is involved to such a great extent. There's no question about this in my mind: it's wrong, wrong, wrong. Counselors are not equipped to administer medications. I very occasionally send one out for special reasons: if the kid is already in bed and getting them up would be too hard on her, for instance. When I was a counselor I had a kids a couple of times who needed their medication immediately on waking, and I kept one dose at a time with me and gave it in the unit. But multiple medications? Every night? WAY too much room for error! I have serious doubts about this camp director's understanding of risk management, to be honest.

I feel the same way. I was told that at his old camp, "only 5 - 6 kids came to the HC on a typical day" - he maiy be in for a rude awakening here. Last year we logged in about 50 on a typical day, 60 some days. He has cut back the amount of kids that will be camp at any given time to 160 - 180, down from around 240 per session. But these kids come from the city and many have chronic conditions and are on meds and there are fights and injuries. A lot of pychotropics.

Last year we had a girl on growth hormone, getting a nightly injection (Genotropin pen) and another girl was getting nightly v. supp. (Premarin).

I also like to SEE my kids who take daily medications, no matter what for. Allergy pills? Gotta assess how they're working. Anti-depressants? How's the kid feeling? Pain medication? Is it effective? etc.

Of course, and I have a feeling this is going to mean a lot of work on my part in tracking down counselors to bring the children to me - hey maybe they'll find this will not turn out as convenient for them as they think.