I have two students (both 6th graders) with moderate asthma who carry their inhalers in backpack. Parents cannot get act together, so I don't have med consents. I finally asked students to bring inhalers to front office and explained to them that if they feel wheezy, they need to come to the office.
I have fully explained (multiple times) to parents that their "grace period" is over and that from hence forth, the parents will have to drive to school and administer medication because I don't have a physician's written consent or their written consent.
But what if a student has an asthma attack, the parents are 30 minutes away, and I am left with a very wheezy student and an inhaler in my hand?
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.
Here are my concerns: You state that safety (access to inhaler) is your #1 priority, but by confiscating them, you are denying the students access to their emergency medications outside of school hours. I don't know how that would be defensible should one of those kids have an asthma attack and no inhaler on hand because it was locked in your office over night. I see that as a far greater potential liability that the possible misuse of the inhaler by a child on school property. Also, since you believe that the inhalers are legitimately prescribed, and not being mis-used on school grounds, I'm not sure you have any legal basis to confiscate them without immediately returning them to a parent. You are essentially depriving a student of his or her own property unless you are returning them every night to the parents, in which case, get the darn forms signed at that time.
As far as "turning a blind eye," I don't mean do nothing. I mean leave the inhalers with the kids who you have reason to believe have legitimate prescriptions while you work (and document) to correct the situation. Do you have records of phone calls to parents? Have you involved the principal? School social worker? Sent certified letters to the parents places of employment? How do these kids get to and from school every day? Has anyone met the parents face to face in the pick-up line? Has the school resource officer knocked on the family's door? Is this serious enough to contact CPS? I believe that documentation of these measures to gain parental compliance would present a far more convincing and defensible argument of protecting child safety than removing a necessary emergency medication from the child.
I feel for you. We have all dealt with these kinds of situations, and they are unnecessarily time consuming and frustrating.
Muno, School policies require more than a prescription label for students to self-carry medication, and are based upon state law. Feel free to research this on your state health department website.
i just want to add and clarify that i don't confiscate the inhalers. I advise the students that they aren't supposed to be bringing them to school without orders - but for the same reasons that Jolie stated - having access to them overnight, legality of confiscation - i won't take their rescue inhaler. (I may hold it on my desk if it 's a very young child and have the parent pick up along with the action plan or if going with daycare maybe will give to those employees) Now if a find a child carrying different medications - yes - that is a different story. I just had a child that thought it would be a good idea to take it upon herself to take what was left of her sisters unused penicillin and bring it to school. I called the parent, got the principal involved and left a message for the parent that he would need to pick that bottle up from me. That bottle is still locked in my cabinet.
I have had this situation before. The parent has gotten a note from the pharmacy that verifies the order info that would prove it is the right medicine for the right kiddo. Just thought I would throw that out there. In my schools. A prescription pharmacy label is considered my orders for most things.
"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.
I'm not a school nurse, so take this for what it's worth as I don't know the full legalities involved (it was a side bar thread I thought could be interesting). I agree that a 6th grader can generally self-administer. My 8th grader was dx'ed with asthma last year when she joined the cross country team. She carries an extra inhaler in her backpack at all times. In fact, she wasn't required to have an inhaler in the nurse's office, but the school RN recommended it because sometimes kids forget it at home. She was also swimming competitively at the time, so would always move her carry inhaler from her backpack to her swim bag...so anyway I did opt to keep one at school in case she left it in her swim bag.
I wouldn't have confiscated the inhalers and would now give them back--especially if the student only has 1 inhaler. As others have said, they need to be able to access it immediately. What if they came for it while you were at lunch or in the BR? That could mean 2-3 minutes at least, and that's a really long time when they can't move air.
Also, a child doesn't need an extra "order" to take their meds. They have one--it's called a current Rx and a parent's consent.
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
Also, a child doesn't need an extra "order" to take their meds. They have one--it's called a current Rx and a parent's consent.
that depends on the state - trust me - i'd love it if all i needed was the RX label and a note from the parents. I take no joy in requiring extra paperwork. The bureaucrats in my lovely state decided that we need more forms. I just love having more forms
I work with high school kids, and am weeding through medication permission forms even as we speak. In my state, we consider a prescription bottle/box a physician order for 15 days from the rx date, after that I need a written order. I also need a medication administration consent form signed by parents. I do not call doctor's offices for orders. Right now I am looking at 30 + "My student has permission to take his/her inhalater (actual spelling)." without any provider order. So I start with the letters and phone calls to parents to have them obtain the proper documentation for THEIR child.
I know I have kids out there carrying epi-pens and inhalers without my knowledge as well.
I have standing orders at my school to administer an albuterol inhaler (I have a stock inhaler) to any student who presents with asthma symptoms who do not have their personal inhaler.
Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.
I work at an allergy/asthma office. We fill out asthma action plans (inundated the past 2 months). We work with 2 different school districts. One district, 6th grade is middle/junior high & they are allowed to carry inhalers, Elementary is K-5, school nurse holds all meds.
When I prescribe rescues/albuterol inhalers I write: Disp #2, one for home, one for school, same for EpiPens,one for home, one for school, & one for babysitter if needed. Do you not have inhalers that are left in nurse office for the entire school year?
Give the inhalers back ASAP. Most states are right-to-carry states, meaning the pt can carry their life-saving medication (albuterol/levalbuterol inhalers, EpiPens) on their person as long as they know how and when to use it. Yes, the schools do require the parent forms filled out but if the kid was at home and had an asthma flare up they'd know what to do, so they should have the same access and knowledge at school. The reason the right-to-carry laws were passed is because an elementary-school child started coughing during class (asthma, but teacher didn't realize that) and was sent to the nurse's office; child passed out in the hall and was found by staff member after it was too late--all that is per the American Lung Association. If the parents won't return the call, ask the child who their PCP or asthma specialist is and call their office to see if they can reach out to the parents. I had to do that on behalf of a school nurse once when I worked in allergy/asthma. We dreaded early August because we knew we'd have TONS of those forms to fill out but we also knew how vital it is to the kids and schools. Good luck!
Bottomline: if in a court of law, I want to look like I'm doing my job and being reasonable.
Jolie, BSN
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