end of year sending meds home

[Apples&Oranges]

So, I am working as a PT school nurse right now, and I will be sending letters home next week about meds going home in June. I have a form letter left by the previous nurse (I am a permanent job sharing sub- NOT a CSN) and I am comfortable sending things like inhalers, Epi Pens, Ibuprofen, Celexa, etc., home with Bobby on the last day - not that any of them will show up to get them.

Here's my question: While I will not, under any circumstance send little Bobby home on the bus with 20 IR Ritalin/Adderal tabs (for him to sell, get stolen, crush and snort himself, whatever,) is it ok to send XR Ritalin home on the bus? I read that even if opened and crushed the beads in the XR capsules will not get one high. IDK if this is true (never tried it, ha!) but would you feel comfortable sending this med home with a kiddo? It is still a class 2 controlled substance, right?

Obviously if the kiddo/parent does not come in to claim it, I'm just going to throw it out with a witness anyway, but if he or she does stop in and want to take a controlled substance home on the last day, what should I do?

BTW, I cannot find a facility policy on this, even after asking the secretary (who legit knows EVERYTHING) or the principal.

Any guidance would be appreciated! Thanks!

[KKEGS, MSN, RN]

We do not send ANY of those types of meds home in a backpack. Our parents know this and also know that if meds aren't picked up on the last day of school they are sent with our school resource officer to be disposed of properly.

[Apples&Oranges]

When you write "those type of meds" do you mean controlled substances or ANY meds? For example, I have a kiddo on liquid Oxycarbazepine - would you send that home? I suppose it could be abused, if one were creative. But it's a huge 20 mL half full bottle, and I assume expensive. I would hate to dump it down the drain just cause mom didn't open an envelope. Also, Epi Pens are super expensive. I would never want to throw one away, even if it was expired.

Thank you so much for the reply, could you clarify? Thanks.

[Eleven011]

I send a note home a few weeks before school ends, letting parents know that I have _______ meds left in the office for Billy. Then I have a space for them to sign to either send the meds home with the child, or they come into the office and pick it up. I also note that any meds left in the office after the last day of school will be destroyed. If the parent signs that they want the med sent home, I give it to the child the last day of school, note on the form how much and what was sent home and keep this form in their file.

[Apples&Oranges]

Actually, that's another good point. I read our state CODE, and it stated that all meds (controlled or not) only have to be disposed of by an RN and should be witnessed by another adult. I was planning on doing this in the trash and documenting a note with the secretary in the school's internal system.Counting the meds together, wasting them together, having her sit with me while I wrote the note/count in the kiddo's Echart.

Is that too much? Am I overthinking this? Is there a safer way to do this? I mean, I know there technically is - I could theoretically get a city police officer to take them, but that seems a bit of overkill. Even writing that seems silly. Again, I am new to all of this. Emergency sub. Be patient with me :-)

I guess I'm so used to acute care where every single mL of a dilaudid PCA bag or Fentanyl waste is witnessed that it's second nature to be super focused on accountability.

How do you all do this in real life? To CYA? Prove that I didn't take a bunch of Bobby's Claritin (or Ritalin) home with me?

There was actually a break in last year in which summer staff stole a ton of left over controlled drugs that were not wasted by the previous nurse. That has me spooked. Maybe that's part of the reason I am being hyper-vigilant about this.

Again, thanks so much for any suggestions.

[KKEGS, MSN, RN]

Yes I meant controlled substances. Epipens and glucagon I save with parent permission to use for training. We also notify our parents via phone call not a letter so we tend to get all of our meds picked up. Last year we only had one medication that wasn't picked up at the end of the school year.

[caliotter3]

Frankly, I don't think that anyone can be too careful. You never know which parent will choose to create a problem or a ruckus. Best to cover one's posterior when one can.

[OyWithThePoodles, RN]

I send home a note that states their child has medicine in the office and will need to be picked up by this date, and if not it will be disposed of properly. If the child's parents are divorced, a letter goes to both homes. We have an awards day on the next to last day so the principal will make an announcement as well. If a parent picks up a controlled substance, they witness with me.

I will usually give a few days after school lets out, even though I am not here, the secretaries are and know what to do. I then come back and pick up the meds, and will attempt to call the parents two or three times. Epi-pens we save, Diastat gets squirted into kitty litter, as do liquid meds (witnessed with our DHC if needed), pills get dumped into a bottle of glue.

[Flare, ASN, BSN]

i send letters home stating that medications need to be picked up by XX date at XX time or will be disposed of. I also tuck a renewal form in. Those that choose not to come in (most ) have their medications brought to my local pd - which i honestly don't know if I would do if I didn't have such a great relationship with them. The thought of driving around with 5 bottles of ritalin with various names on it gives me the 's but my pd knows me and they have a drop box for disposal and would not question me doing so. If I had to drive 4 towns over to drop the meds I would feel entirely different and would probably call the PD to arrange a pick up from them.

The big problem I run into is that the local EPA standards here do not want us to pour liquid meds down the drains. The fish develop hasty drug dependencies ha ha. So I have a medication graveyard of 3 or 4 bottles of liquid ritalin that no one can exactly tell me what to do with. I suppose I can do the trick with the coffee grounds...

[OldDude]

Over the years I've sent letters and made phone calls about this and still end up with medicine not picked up. Several years ago I stopped with any notification and I end up with the same amount of medicine not picked up. I lock it up until the beginning of next school year. If it hasn't been picked up by then I toss it.

Upon parent request, I'll send an inhaler home with a student but that's about it.

[NurseBeans, BSN, RN, EMT-B]

So I have a medication graveyard of 3 or 4 bottles of liquid ritalin that no one can exactly tell me what to do with. I suppose I can do the trick with the coffee grounds...

I don't know, coffee brewed with ritalin sounds like a pretty good start to the morning...

[Flare, ASN, BSN]

Over the years I've sent letters and made phone calls about this and still end up with medicine not picked up. Several years ago I stopped with any notification and I end up with the same amount of medicine not picked up. I lock it up until the beginning of next school year. If it hasn't been picked up by then I toss it.

Upon parent request, I'll send an inhaler home with a student but that's about it.

Well, now the board office is on a new kick to not send letters home to "go green" more so to save on postage. I can agree with it on some cases. But they told me the other day in a less than pleasant tone as i was mailing out my sixth grade vaccine notices. We don't send out paper report cards, they don't want me to mail letters. I am guessing a lot of kids will be excluded come september when they haven't been hounded by mail.