MD orders to discontinue...?

OldDude · Feb 25, 2019

I'd be OK with "stopping" something with a verbal from a parent...

AdobeRN · Feb 25, 2019

I will take a verbal d/c from parent - I do request it in writing just to be on the safe side.

UrbanHealthRN, BSN, RN · Feb 25, 2019

I guess it depends on the med for me. If it was some sort of medicated skin cream, for example, if the parent told me it was done being used, I'd be fine. If a parent told me their kid didn't need an albuterol inhaler, or Epi-Pen, or something else anymore, I would want to verify with the doctor.

ADHD meds seem somewhere in the middle of these two examples. When a kid is going through a lot of ADHD med changes while a med plan is finalized, I like to have paperwork from the provider coming in that reflects these changes. For some families, it also helps them to stay on track with the changing med schedule.

LikeTheDeadSea, MSN, RN · Feb 25, 2019

I request in writing from the parent just to be sure. I need MD order AND parent permission to give medication, so parent request is enough. I just like to have written as proof.

ruby_jane, BSN, RN · Feb 25, 2019

I used to accept parent orders (written). Then someone questioned that practice, because it's a doctor that ordered it....we're in a weird place, being an extension of the home environment. Hasn't happened since but I feel like I need something in writing from someone to stop a medication.

OyWithThePoodles, RN · Feb 26, 2019

I will simply get something in writing or email. We have to have the parents permission to give the medicine anyway, so I feel like them asking to dc it is not giving their permission anymore, that's their right. Do I always agree, no.

jess11RN · Feb 26, 2019

I take a verbal from the parent. Heck, if I'm out of meds and parent don't bring in a refill, I can't really give it anyway, right?

k1p1ssk, BSN, RN · Feb 26, 2019

All valid points! I definitely would agree on d/c orders from a doc for an epi-pen d/c... I think for a child with chronic/poorly controlled asthma (not illness or exercise induced), I would also ask for MD d/c orders...

For this particular scenario, its the same med, just with a time of admin change, and the MD order reflects the new timing; Verbal confirmation from mom with a valid explanation I think will suffice in this scenario. As @OyWithThePoodles said, they gave permission to admin in the first place, they should be able to revoke that permission at any time!

I will probably take a hard line stance for next school year, however and require a written d/c from a parent for any ADHD changes. THis year was more about finding my footing and making connections with families... THanks everyone for your input!!

RatherBHiking, BSN, RN · Feb 26, 2019

For ADHD meds, I stop when the parent says stop (and document it) but I do ask for a written note "just for my records" and they usually do. Like someone else said, I need their permission to give it anyway and it's not like if they don't have it their health will be harmed, just learning.

On our med forms it does say we have permission to talk to the dr so if I suspect the parent may be selling the pills I will fax the dr notification that the parent has told us to stop just so they know not to keep prescribing it or that something is going on but that rarely happens.

If it's discontinuing an epi pen, I do get a dr's order just because I don't want held liable for an anaphylactic reaction since that could be considered neglect by the parent if they just decided to stop a life saving medication for no reason.

They don't usually discontinue inhalers here, they just don't give me a new one the following year. If the child hardly ever used it at school then I don't worry about it. If they used it all the time I make a phone call and see what's going on.

beachynurse, ASN, BSN · Feb 27, 2019

On 2/25/2019 at 2:37 PM, UrbanHealthRN said:
I guess it depends on the med for me. If it was some sort of medicated skin cream, for example, if the parent told me it was done being used, I'd be fine. If a parent told me their kid didn't need an albuterol inhaler, or Epi-Pen, or something else anymore, I would want to verify with the doctor.
ADHD meds seem somewhere in the middle of these two examples. When a kid is going through a lot of ADHD med changes while a med plan is finalized, I like to have paperwork from the provider coming in that reflects these changes. For some families, it also helps them to stay on track with the changing med schedule.

Since we have to have an MD order for every medication, that's not an issue for me. Any change in dosage or medication would need a new order, so if Mom tells me that they are stopping meds, I am ok with it, but I usually ask the parent to put something in writing for me just in case.

magdarly · Mar 1, 2019

On 2/25/2019 at 2:14 PM, k1p1ssk said:
Hi All! Do you require MD orders to DISCONTINUE a medication, or at the very least a written request to discontinue from the parent? Or would you take a verbal request from a parent?
I'm curious, especially surrounding trials of new ADHD meds and there hasn't really been consistency with nurses in my area (I used to work an ADHD clinic and it seemed to be a crapshoot whether or not the area school nurses wanted MD discontinuation orders or not...)
In particular, a student in my clinic was taking an ADHD med at lunch, and I just received a new med order for the same med to be admin at 3pm. I clarified with Mom that this is to be given in lieu of the 12:45pm dose, so I'm wondering if I can just take mom's word for it (and document it of course) or if I should request a d/c order from her PCP.

I would definately get an md order to stop any medication, its for your own protection