Give inhaler w/o doctor's consent?

anh06005, MSN, APRN, NP · Sep 25, 2015

As a medical professional I'd give the inhaler and deal with consequences later. It'd be better to ask forgiveness for that than a child pass out from hypoxia.

I wonder if the principal or superintendent could get involved in the situation?

Jolie, BSN · Sep 25, 2015

Do I understand correctly that you now have possession of their inhalers in your office?

If so, I wouldn't have done that.

I understand the pitfalls of a student self-carrying unauthorized medication and applaud your attempts to correct that situation. But if you have taken the inhalers from them and are keeping them in your office, you have effectively denied them access to that medication for all but the 6-8 hours/5 days per week that they are in your building, unless you return it to a parent or responsible adult at the end of every school day.

If one of those children experiences an emergency for lack of an inhaler, I believe that you and the school may be held responsible.

If one of the kids needs the inhaler and comes to your office, you might as well hand it to him and observe his use of the medication. By 6th grade, I would expect most children to be able to use an inhaler independently. And that is probably what the parents intended. Although I agree that they have gone about it the wrong way by not providing necessary documentation to the school.

I don't believe the best interests of the students of this age are met by confiscating inhalers, nor do I believe the safety of the school to be seriously at risk because they are in possession of them, even if such possession is unauthorized.

I hate to admit this, but sometimes it's better to turn a blind eye, while working to correct a situation, usually by getting administration involved.

clockwood · Sep 25, 2015

Thank you both so much for your replies. I agree with a lot of what you are saying. I am also of the opinion that by 6th grade, the kids are able to use their inhalers independently. Also, that safety (i.e. access to inhaler when needed) should always be #1 priority.

Here's some more on my thought process: When I called one parent in the beginning of the school year, the mom said, "Oh, yes, in fact my daughter does have bad asthma." To which I replied, "Does she require an inhaler at school?" Mom replied, "Yes, it's in her backpack at all times." ....So now that I am knowledgable of this information, I am complicit in allowing her daughter to carry a prescription medication and self-administer it with no verifiable order. How long do I turn a blind eye to this? I gave parents 2 weeks of "blind eye" action with 2 reminder calls in-between.

Before taking the inhalers to my office, I notified the teachers of the situation. I also called the parents to remind them to pick up medication after school - my concern being that the students likely do not have an extra inhaler at home. Secretary advised me that these parents need an ultimatum in order to take care of business.

All of this being said, in most circumstances, I likely would end up letting the student use the inhaler under my supervision, with or without a doctor's order. I guess we just have to use our "nursing judgment" right? Bottomline: if in a court of law, I want to look like I'm doing my job and being reasonable.

clockwood · Sep 25, 2015

Thanks for sharing. Good to know. The common sense/intuitive side of me would give the inhaler. But the anxiety side of me sees Judge Judy rhetorically yelling, "YOU GAVE A MEDICATION WITHOUT AN ORDER???" haha

blondy2061h, MSN, RN · Sep 25, 2015

Does the district have a policy on this? You're taking guidance from the secretary. If one of these students has a severe attack and doesn't have access to their medication, what will happen to the secretary? What will happen to you (and your license)?

sallyrnrrt, ADN, RN · Sep 25, 2015

Does the prescription MDI inhaler, not have patient name, Dr Name and directions?

That is "sorta an order"........I have never worked as school nurse, and honestly have

no idea of requirements.......I hope parents follow through....

nrsang97, BSN, RN · Sep 25, 2015

Does the prescription MDI inhaler, not have patient name, Dr Name and directions?
That is "sorta an order"........I have never worked as school nurse, and honestly have
no idea of requirements.......I hope parents follow through....

The inhaler only has the name if it is in the box. Otherwise it is just an inhaler unlabeled.

Home Health Columnist / Guide · Sep 25, 2015

Moved to AN's School Nurses forum to get advice from the experts in this specialty.

The National Association of School Nurses has following position statement:

Asthma - National Association of School Nurses

Suggested Emergency Protocol for Students with Asthma Symptoms - Although each student with asthma needs a personal asthma action plan, schools also should have a written emergency care plan for students who do not have a personal plan at school. This template can help develop a district or school protocol.

MunoRN, RN · Sep 25, 2015

I'm not familiar with school policies, but it would seem pretty reckless to take an asthmatic kid's inhaler since being "left with a very wheezy student" is one of the better scenarios that could occur, a dead student is also possible and it's happened before. Canada now has a law that requires schools to allow kids to carry rescue puffers after a 12 year old boy died after his school confiscated his puffer.

Ontario law passes to let asthmatic kids carry inhalers in school - Toronto - CBC News

Bronchodilators are prescription medications, so it would seem likely the doctor has already given consent and an order, that's what a prescription is.

Flare, ASN, BSN · Sep 25, 2015

i don't turn a blind eye at all. The student gets called down to my office once i learn that they have an inhaler on them and they get awarded a blank asthma action plan to take home along with a follow up call explaining that the order needs to be in every sept even if they plan on carrying it in their back pack. I also add that not having the order can be viewed as carrying drugs to school. I then let them know that the order form can be found on my website 24/7, 365 and that the doctor can fax the order back to me for speed's sake and that if the student needs the inhaler before I get the order back that the parent can feel free to come in an administer or if not available and if the asthma attack is bad enough, I'll be sure to call EMS. I usually get action plans returned within a day or two that way.

I am sure that I have plenty of other offenders carrying clandestine inhalers in their backpacks. Epipens too. All I can do Is just continue to repeat policy. You can lead a parent to the doctor's office, but you can't make them get the form's filled out.

JenTheSchoolRN, BSN, RN · Sep 25, 2015

I have an asthma detail form ready for this to cover students that self carry. It is signed by the parent and must have an asthma action plan stapled to it provided by the doctor (and signed by the doctor) with medication specifics. It has been much more effective than providing the previous blank medication order form I used to give as it gives me more details. It has check boxes, including one that states "my child only has one inhaler and keeps it with him/herself during school hours." Under that, I also include permission for parents to allow self-admin to cross every T I can. If a parent has told me their child has asthma and I have no other paperwork, that form goes home with the child and another copy is mailed home (and sometimes I also email a copy to the parent). It has been very effective and I have gotten 90% of forms returned within a couple of days.

I won't deny a student their inhaler. Since I deal with the older kiddos (7th-12th) I advocate self-carry all the time. Having an asthma attack on the third floor when your inhaler in is my office in the basement doesn't help.

But when a parent doesn't provide paperwork despite this, I reach out to my principal - that usually always helps :).