Determining New Students Health Needs...

[KKEGS, MSN, RN]

Had a situation today that's making me feel like crap. Like I dropped the ball.

The mother of a new student at my middle school called the principal very upset that she was not notified that her son had a reaction to peanuts at school. We did not know he had a peanut allergy. We received no phone call or note telling us he had a peanut allergy and we do not have Benedryl or an EpiPen in the health office for him.

I'm not sure when this reaction took place since the last time we had him in the health office was Tuesday and his complaint was a sore throat, which in retrospect could have been a reaction. He did not tell us he had a peanut allergy. He told us he has asthma so I listened to his lungs and he was clear throughout all fields. He had a cold drink of water and went back to class. I'm not sure if he told his mother that night or today. If his reaction was today he never came to the health office to tell us.

My health aide did find an anaphylaxis plan in his student health file. Not sure when it arrived since it usually takes several weeks for us to get records from new students' previous schools. Obviously it did arrive though and someone tucked it in there.

Anyway, I'm wondering if you all contact the parents of each new student to ask about health issues, medications, etc or wait until the health records arrive from the old schools? I want to avoid this happening again! I also think a contributing factor is that this student started in the first few weeks of school when I felt like I was drowning. I'm brand new at school nursing this year and was still figuring out which way was up.

I've also had plenty of new students with parents who are on top of it and let us know about serious health issues right away and get meds and orders set up promptly. I know not all parents are like that so I can't expect all of them to do it. I just feel bad that this kid could have been in a dangerous situation and I had no idea.

[grammy1]

When our registrar is entering a new student, there is a space on the registration form for health conditions. If they list anything on there, she sends them to us for follow-up. It is up to the parent to notify us, not for us to use our ESP to guess. We also let the student carry his inhaler or epi-pen while we're waiting for the doctor's MMP to be returned. I will not subject a child to a possible life threatening reaction without their medication.

ETA--we do have a copy of the prescription label, which generally acts as the doctor's order.

[GdBSN, RN]

You don't know what you don't know. If you were never notified that this kid had a peanut allergy, why would you even suspect that. As a parent, they should be in your office day one with doctor's orders and a Epi-Pen. Thank goodness the student is Ok, but c'mon, parents need to take resposibility for the heath and safety of their child.

[Cat365]

Are you saying that the school was notified but that it just got filed away and you never saw it?

if so, I would address that. You can't be responsible for what you don't know, but if your office was informed and you still didn't know that's an issue.

[JenTheSchoolRN, BSN, RN]

I have a health form I include in our new student packets; same form I [try to] have every parent/guardian fill out every year for their child. Usually I can catch things there and [try to] track down paperwork/etc from there.

[Cattz, ADN]

Good grief. I am so sorry you are feeling so bad about something you didn't know. The parent knows the kid better than anyone in his new school can at that point. I try to get the Health Enrollment Forms on the kids before they come to school. But, seriously, if the parent didn't tell you, then that is on the parent. Glad the kid is ok, but geeeeeeeeeeeeee, if you didn't know, you didn't know. I would address if the allergy paperwork got filed away without your knowledge.

[BeckyESRN]

That's a rough one. Clearly the kid didn't have an anaphylactic reaction and outside of a kindergartener, I would think that a kid with an allergy history would say "My throat hurts, I think I accidentally ate a peanut and I'm allergic". Heck, I've even had a kinder come to me because her friend sneezed on her after eating a PB&J and she was worried about exposure. Parents of allergic kids get A LOT of leeway from me, the anxiety of constant worry means they get a bit of a pass on bad behavior as long as they are willing to work with me to fix the issue. Mom needs to know that, yes you saw her snowflake, your assessment was WNL, no mention of allergies or exposure. Then address that you did find a copy of an emergency plan, which was filed without your knowledge and assure her that that systems error is being addressed. Next say that it is crucial for you to have emergency medications on hand along with the doctor's order.

[MrNurse(x2), ADN]

Every parent of an allergy student I know screams it from the rooftops. This mom may be lashing out because of her own guilt for not telling you personally.

[NutmeggeRN, BSN]

Upon registration we give the them the form that that is filled out by everyone the first week (or so) of school. If I see the parent, Iask them directly, but often, I am the last to know!!!

[Flare, ASN, BSN]

We also have a health history form that a parent fills out upon registration that I review. But in the absence of that form, it 's the parent's responsibility to inform you that the child has an allergy. Honestly, I can't tell you how many times that form hasn't helped me a lick and it was just by chance and chart review that I tripped over the fact that a child had an allergy and when called the parent would say "oh that old thing?" because their level of give a crap about the allergy had gone down 30 fold. But I still addressed it and covered my butt.