Mistake? Maybe?

[MsNurse1997]

I’m a full time float nurse for my school district, 22 schools total. I do a lot of long term sub positions for nurses on maternity leave, sick leave or for schools whose nurses have quit and waiting to hire a new one. I’ve been at this current elementary school for 2 weeks now. Today I saw a little kindergarten girl for a headache and sore throat/cough. No fever, throat had some post nasal drip and was a little red. Suspect it was all allergy related as we live in the allergy capital of the country I feel like. I have her some cough drops and a small dose of Tylenol and sent her back to class. Later on in the day I was checking my charting and noticed a little note in her caredox chart saying something along the lines of “Must call mom for permission for any OTC med including cough drops every time. Mom does not want student having meds.” Mind you this was not a flag or alert on her profile. Just a little extras note. He’s drop down OTC permitted tab had permitted Tylenol, Cough Drops, Tums and Bacitracin Ointment. All of this was permitted back in October of 2021. The note entry I mentioned earlier was from February of this year. I obviously did not notice the note earlier as it was not flagged so I just looked at her permitted meds and gave it. The nurse that wrote this note should have removed all the meds off permitted list so this would not occur. We are all trained that if it’s not selected on the permitted list, call, if it is selected, you can go ahead a give it as it has been okayed in the past. Hopefully I don’t get a call getting cussed out tomorrow for this. I was not relayed much information at all on the kids at this school with how the prior nurse left unfortunately. I feel like this is a med error but at the same time her permitted list was still active so I’m not sure what to do. My boss did not seem to be concerned about it. 

[Glitternurse, LVN]

That would be very confusing, I'm sorry this happened. You spoke to your supervisor which is good. I suggest you also speak to the parent, apologize and let her know what happened. I feel like the parent may be upset, ut less so hearing it from you. In California we can not give any medication without a doctor's order, parent permit signed and parent supplied medication. It's definitely frustrating for some of the parents (and honestly for us sometimes), but I also feel protected by it. I hope all works out well for you and mom is understanding.   

[Jedrnurse, BSN, RN]

It seems that this "addendum" would need to be in the main order section (as a flag) in order to have a chance to be seen. Having it separate from the order and consent that say you can give the meds doesn't make sense.

[MsNurse1997]

Yes I agree. I moved the note to the alerts section so it pops up on her profile when opened and I also removed all meds from her permitted list. The teacher messaged the parent about it yesterday actually and she was fine with it. Turns out the reason why that note was put in was because the student was coming to the nurse all the time to get cough drops and mom was tired of her missing class and wasting the nurses cough drops. LOL. But I still made the changes to the profile so it won’t happen again in the future. 

[Glitternurse, LVN]

I'm happy to hear it all turned out well.

[2BS Nurse, BSN]

It would be silly for a parent to get upset about a single dose of Tylenol (unless the child was allergic or had a another contraindication).  Sadly, parents can be unreasonable and you just never know these days. My father had a motto "what doesn't kill you makes you stronger". Of course, his generation trusted nurses completely.