Field Trip PRN Medication Delegation (Texas)

[BunnyBunnyBSNRN, ASN, BSN]

Good morning, All!

With field trip season around the corner, my co-nurse and I were talking about delegating inhalers to teachers and other unlicensed persons, specifically PRN inhalers.  Per the BON, if the task requires the exercise of professional nursing judgment, such as: physical, psychological, and social assessment, which requires professional nursing judgment, intervention, referral, or follow-up; the the task cannot be delegated.

My interpretation of this is PRN inhalers, or other medications, such as anxiety meds, would not be able to be delegated since there is a nursing assessment and professional judgment involved in determining if the medication is needed. 

 

Please understand, the absolute LAST thing I want to do is go on a field trip.  I'm concerned about our nursing licenses and want to ensure they are not in jeopardy.

School Nurse Delegation Decision Trees.pdf

[k1p1ssk, BSN, RN]

In MA, we are not allowed to delegate any PRNs with the exception of EpiPens for students who have a specific order. There is legislation in the works to be able to delegate glucagon in many states however nothing for albuterol to my knowledge. Having stock albuterol as a standard may also be in the works... 

With that said, we do not send nurses on field trips where just inhalers are needed UNLESS the student is particularly severe, or has had recent illness or flare ups. We usually communicate with the families ahead of time to make sure they understand that and if they don't agree and want a nurse to go, even if LD has never used the inhaler in school, we do our best to get a nurse. But, depending on the age of the student, we'll sometimes suggest the family get a new order for student to self-carry/self-admin. Many are more concerned about the med going rather than a nurse. 

This is also the reason that we often do medication administration plans in addition to the doctor's orders. We're supposed to always do one, but most of them end up being a carbon copy of the MD order, and so it's redundant.

Occasionally, we'll get an order set that wants us to admin benadryl or zyrtec BEFORE giving epi (which is infuriating because it is not best practice, especially for students with a history of anaphylaxis). And so, a routine epi order that doesn't require a nurse automatically means we need one. With these, I write the med admin plan, which includes "Field Trip Plans" and I make it clear that the antihistamine will NOT be sent on the field trip and that a nurse will NOT be present. I've never had a parent not sign off on that, even when I've very specifically pointed it out. If I sense any hesitation, I usually tell them that it's safer overall to just give the epinephrine rather than give benadryl with a hope and prayer - and that if anaphylaxis is to occur, benadryl/zyrtec are unlikely to stop it, just delay and they'll need epi anyway. 

[kararene]

In Texas at my job we follow Texas Administration Code 225, which is the same for school settings. You can delegate inhalers, etc. The order must state when it is to be used. Then the delegating RN must ensure the unlicensed staff know the signs and symptoms as well as when to call 911, etc. I delegate unlicensed staff to do g-tubes, insulin, all medications, PRNs, and more for group home clients. 

[sergel02, BSN]

I could be wrong, but in California we can delegate inhalers, at least where I work. Now, the RN is in charge of training and doing the Care Plan and Emergency Plan on what to look for. 

There are so many kids with asthma I don't know how we'd staff if an RN or LVN had to go on every field trip that had a kid with asthma. We'd probably need a field trip nurse LOL