Medication Consent

[SchoolNurse91, BSN, RN]

How does your district handle medications?

We currently only require the parent's signature for OTC meds.

We require parent AND physician signature for prescription meds. This was changed a few years ago. We only required a parent's signature as long as it had the pharmacy label.

The problem is that we have a lot of parents with little/no resources or they simply don't care to get the paperwork signed by a physician. I have three schools and no aides. It's difficult to "harass" the doctor's office to sign these forms. Meanwhile, I have inhalers that I can't give because of no physician's signature.

[BrisketRN, BSN, RN]

We follow Illinois' state law that indicates physician authorization for all medications OTC and prescription. I'd advise trying to see what your state law is. Perhaps you could contact your department of health or school board of education.

[SchoolNurse91, BSN, RN]

As far as I'm aware, there is no law. There is a recommendation that the form be signed by the physician. I've consulted with districts around me. Some take the pharmacy label and some require a signature. I'm at a loss because these kids need their inhalers, or god forbid their epi pen. I've called 911 already this year because we didn't have a signature....had a perfectly good inhaler.

[cid1]

Is it an inhaler or Epi pen prescribed for a specific student? I would not withhold care and cause a 911 call/hospital visit if I can give a prescribed inhaler. With or without a signature

[SchoolNurse91, BSN, RN]

Just now, cid1 said:

Is it an inhaler or Epi pen prescribed for a specific student? I would not withhold care and cause a 911 call/hospital visit if I can give a prescribed inhaler. With or without a signature

Yes, specific student. However, this isn't an issue for one student. It's a problem for many, many students. If I truly felt the student was in distress, I'd give the medication. However, I don't want to make a habit of giving medications against policy.

The case above wasn't an emergency. Needed an inhaler but no immediate distress. 95% on RA with very mild wheezing. I told the mom she had to pick up the student but she said she didn't have a way to come get the student. Since I didn't technically have authority to treat, I called EMSA to give him the albuterol.

[BrisketRN, BSN, RN]

If you can legally take the pharmacy I'd go with that especially for emergency medications. I have allowed the use of inhalers based on prescription label if it was an emergency and the form wasn't signed. Then I make sure parents get the form signed (usually involves me faxing it for them).

[ruby_jane, BSN, RN]

42 minutes ago, kelleyk1991 said:

Yes, specific student. However, this isn't an issue for one student. It's a problem for many, many students. If I truly felt the student was in distress, I'd give the medication. However, I don't want to make a habit of giving medications against policy.

The case above wasn't an emergency. Needed an inhaler but no immediate distress. 95% on RA with very mild wheezing. I told the mom she had to pick up the student but she said she didn't have a way to come get the student. Since I didn't technically have authority to treat, I called EMSA to give him the albuterol.

YEEPS. Yes...this is what I hate. And you are well within your scope to refuse in a non-emergency situation. I dislike intensely when a parent's (in)action puts my nursing license at risk.

At least you have the meds. I've found it's easier to follow up to get the medication form from the doctor than it is to actually get the medication.

Good luck!

[SaltineQueen]

Does your state allow for your district to write emergency protocols for albuterol/epi/narcan when you don't have a doctor order?

We give OTC with a parent signature, and we have an order from our district physician that says something like (XYZ specific meds we stock)may be given per recommended dosing instructions on bottle. (Something like that...no coffee yet)

If I had an emergency med and the label was very recent I'd be OK giving it if necessary. But I also wouldn't have a problem harassing the doctor to get the order. Have the parent sign a ROI and fax them over. I've never not gotten one back.

I am however in a battle right now to get authorization for a 5mg noon dose of Ritalin. I'm not giving that one because it's not an absolute necessity. Fingers crossed the parent will call and light a fire under the doctor's office.

[JenTheSchoolRN, BSN, RN]

My school has OTC orders signed off on by our doc. Includes acetaminophen, ibuprofen, antacid (tums), cough drops, hydrocortisone cream, benadryl (but used for allergic rxn only).

We also have standing order Epi. In talks about new standing orders (that will likely happen next year) for narcan (once I have a team in place to help me if I need to give it; so I'm not alone in my office doing this basically) and albuterol. The albuterol I stock will likely be in neb form vs inhaler, but would cover students with inhaler that I don't get a doctor's order signed off on but I assess needs albuterol.

Prescription stuff (including inhalers) I need a doctor's order. For inhalers, I have the parent sign off on a separate form asking more details about student's asthma and self carry and I staple it to the doctor's order. I also have a sign off on the main health form for prescription meds for parents, but state I will not give without the doctor's order.

Do you have a school doc?

As for denying an inhaler. I don't if student has one with a prescription label on it and I have the asthma diagnosis noted on file, current order or not. (Why I'm exploring the above standing order with my doc.)

Kids can change status at the drop of a hat. Now, if I notice a pattern of inhaler use with stable vitals, etc, it worth exploring with parent and doc. And work on getting the order. To be honest, if I have to I call the child's doctor directly and can usually get it faxed order within a day or two.

["nursy", RN]

Agree with above posters re contacting the provider. Usually if the student has a current order, the provider has no problem signing one of our forms that I fax over, they fax it back, badda bing badda boom DONE.

[NutmeggeRN, BSN]

Parent sig for OTC, but I have the parent sign med permission form and fax to MD. Not ideal but more likely to get it back than not