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Specializes in School.

Hey all, I am new to school nursing and have a thousand questions. I was hired at a private school with about 40 ish students? Right now half or so are online. 

I don't have a lot of guidance from above, my supervisor is not a nurse. 

Asthmatics- one students mom said she no longer needs her inhaler. I documented this. do I need a note from physician? I need to have students parents send in inhalers- how do I implement an asthma action plan? do I need one for all kids with inhalers? do I ask parents to get them filled out or do I speak to provider myself? 

 

admin said its OK for all meds to be brought in on bus even controlled bc many students only transport available is bus  how do I document recieving this? I have no proof of them documenting it before from what I can see. mainly concerned about the controlled med.   

A student with adhd needs her meds brought in- I cant find evidence that last year there was a count sheet for this  should I print a generic one? should it go in her file when done? 

 

thank you all for your guidance!

Keeperofbandages, LPN

Specializes in School Health. Has 7 years experience.

All of my medications must be brought in by the parent who will pill count with me (for any pills), and we both sign that x amount of pills are brought in with the date of medication brought in, time, name of med, med expiration, my signature, parents signature and relationship to student. At the end of the year (or if medication is no longer given at school) we count again at medication pick up and we both sign again that x amount of pills are picked up.  Then it goes in my student's confidential file.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

it's a bummer when you take over a school and feel like you have to constantly reinvent the wheel.  The best you can do in these situations is let the parent know the policies and then wade through your gray areas.  So for example - the asthmatic student that no longer needs an inhaler.  Tell the parent that you need something from the Dr, even a faxed note, so you can update their file.  Document it anyway - you're probably not going to get anything.  This is probably not something that I would fight too hard on.  At the end of the day, it's the parent's responsibility to ensure that orders are submitted and medications are dropped off.  We can only document.  

As far as a controlled med - again, alert the parent that this is can't be brought in by the student.  Even though bussing makes it inconvenient, you still have to enforce policy.  Chances are that the student will still bring it in.  I mean it's not like you're not going to take it, as the alternative is to send that kid away with a bottle of a controlled substance.  But you can always let the parent and even the admin know that this is not being handles properly on their end.  Oh, and document.  Always document.  

Any sort of pill count sheet that you are comfortable with will suffice.  Many of the EHRs have a place for meds and med counts.  

good luck!

k1p1ssk, BSN, RN

Specializes in pediatrics. Has 10 years experience.

@Looking_ahead - I would look into your state's particular laws around medications in schools. If you can't find your state's particularly, you could go through the Massachusetts med program, which is free to audit and takes less than 2 hours. https://www.bucme.org/node/1167

I don't feel you need an MD note saying the student doesn't need a medication any longer, especially with things like an inhaler. It's a whole other story, but I think a lot of people have them who don't actually need them. If the student begins presenting to you with concerning symptoms and you think having an inhaler at school would benefit, then fight that battle.

Most of my "asthmatics" have no action plan on file as most of them have never even had an actual asthma attack (again, a story for another time). If the student has moderate to severe asthma, that is generally noted on their PHE from their doctor and I would follow up and have the PCP or pulmonologist write it. You technically can't anyway, since they're a form of orders. I really like the stoplight versions myself, but there are all different ones.  Get a release from the parent if you don't trust them to get it in a timely manner, then seek it out from the MD yourself. I find in a lot of instances this saves you a lot of time.

Our charting software keeps count, so we don't do anything but document when the parent brought in the controlled substance and how many they brought. In MA, you cannot have more than a 30 day supply on hand (if I recall correctly). I Had a parent try to give me over 180 ritalin tablets last year so they wouldn't have to keep coming in and it was clearly from several different prescriptions (I think they were filling all Summer and not giving the med...) Big no-no. 

I Hope you find this forum a good resource! Welcome!

Looking_ahead, ADN, RN

Specializes in School.

One more question, how do you guys go about obtaining an updated Individual Health Plan? We have one for one student from 2 years ago

ruby_jane, BSN, RN

Specializes in ICU/community health/school nursing. Has 12 years experience.

2 hours ago, Looking_ahead said:

Hey all, I am new to school nursing and have a thousand questions. I was hired at a private school with about 40 ish students? Right now half or so are online. 

I don't have a lot of guidance from above, my supervisor is not a nurse. 

Asthmatics- one students mom said she no longer needs her inhaler. I documented this. do I need a note from physician? I need to have students parents send in inhalers- how do I implement an asthma action plan? do I need one for all kids with inhalers? do I ask parents to get them filled out or do I speak to provider myself? 

I generally don't get a note, but document the heck out of "Parent stated student no longer needs inhaler, declined to provide emergency rescue medication this year."

admin said its OK for all meds to be brought in on bus even controlled bc many students only transport available is bus  how do I document recieving this? I have no proof of them documenting it before from what I can see. mainly concerned about the controlled med.   

NO. Hard pass. Some of that has street value. You are thinking correctly. If this happens, I would document the count with another adult and call the parent, stating that you cannot be responsible for any med you don't receive directly from parent. Also..tell the admin that you are concerned about the liability of a kid selling/stealing meds off the bus. Our district only allows a week's worth of meds at a time; even two week's worth of meds would be preferable to what you have now.

A student with adhd needs her meds brought in- I cant find evidence that last year there was a count sheet for this  should I print a generic one? should it go in her file when done? 

Use your EHR for this. It's a permanent record that cannot be shredded!

 

 

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

1 hour ago, k1p1ssk said:

In MA, you cannot have more than a 30 day supply on hand (if I recall correctly). I Had a parent try to give me over 180 ritalin tablets last year so they wouldn't have to keep coming in and it was clearly from several different prescriptions (I think they were filling all Summer and not giving the med...) Big no-no. 

I Hope you find this forum a good resource! Welcome!

Yep, you are correct. Though I do have a parent that gets a 90 refill through their pharmacy for her kids ADHD meds (not sure how - usually insurance doesn't authorize those, to be honest...). So she get the pharmacy to provide 3 labeled bottles and we split it into 30 day batches. This is kinda great because when I ping her, she already has the next 30 days on hand!

laflaca, BSN, RN

Specializes in School Nursing. Has 7 years experience.

On 10/9/2020 at 5:10 AM, Flare said:

 

As far as a controlled med - again, alert the parent that this is can't be brought in by the student.  Even though bussing makes it inconvenient, you still have to enforce policy.  Chances are that the student will still bring it in.  I mean it's not like you're not going to take it, as the alternative is to send that kid away with a bottle of a controlled substance.  But you can always let the parent and even the admin know that this is not being handles properly on their end.  Oh, and document.  Always document.  

 

Yes, this.  I had a kid last year whose parent sent him on the bus with a controlled medication, and somehow it "fell out of his pocket" en route.  Pretty sure the kid sold it.  Luckily, I had seen this problem coming a mile away - so when I asked for a refill the week before, I specifically had a conversation with the parent explaining that all meds needed to be dropped off by an adult, and then I documented that conversation in the EHR, which of course is a time-stamped entry.  When the meds disappeared, I was not on the hook and there was no question of a possible misunderstanding of policy. 

On other occasions when students showed up with meds, as Flare said, I would accept them.  I would call (or preferably email) the parent to review med policy, and I would note how many pills I received.  And then I'd document both things.  It's wise to CYA with this stuff. 

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 44 years experience.

Such fountain of knowledge AN's school nurses have....welcome to the school forum. They wear pink on Wednesday.

LikeTheDeadSea, BSN, RN

Specializes in School Nursing. Has 6 years experience.

Welcome!  ONE OF US! ONE OF US!

Definitely want to compliment where your head is out - recognizing what doesn't feel "right" from the situation you inherited can be tricky, since changing the way "things have always been done (or not done)" can ruffle feathers.

Definitely take a look at state-level policies, as our district policy is mostly governed by this, and will outline what you do/do not need to do.

My state also has a "School Health Emergency Guidelines" which features generic Asthma, Allergy, Seizure, and Diabetic Action Plans. They are not medication specific, so I use these for the kiddos without individual medications, but could progress to an emergency, even if they've never had an actual episode historically. This way the numbers for chronic/emergent conditions and action plans reflect each other.

 

I suggest drawing a hard line in the sand about having medications brought in by an adult. Especially controlled substances. I'm sure your school has a drug/alcohol policy. I would talk to Admin about student's bringing in any medication as a violation of the policy. As other's have said, even if it is their own medication, they could be selling it.  Even if its older kiddos, I've heard of them sharing an inhaler to feel the heart racing effects.    People who repeatedly send it in with their kiddo because it's inconvenient should be told they're in violation of a policy and disciplinary action will be taken as per those policies.  (And then of course, Admin should be on board, fingers crossed.)

And remember, if you make an exception for one family, you can bet you'll have to make exceptions for all families, so stand your ground on things you feel strongly about!

 

 

beachynurse, ASN, BSN

Specializes in School Nursing. Has 36 years experience.

On 10/9/2020 at 7:33 AM, Looking_ahead said:

Hey all, I am new to school nursing and have a thousand questions. I was hired at a private school with about 40 ish students? Right now half or so are online. 

I don't have a lot of guidance from above, my supervisor is not a nurse. 

Asthmatics- one students mom said she no longer needs her inhaler. I documented this. do I need a note from physician? I need to have students parents send in inhalers- how do I implement an asthma action plan? do I need one for all kids with inhalers? do I ask parents to get them filled out or do I speak to provider myself? 

We have asthma action plans that are to be filled out and signed by the MD. Yes, I want one for each student with an inhaler. I will try and message you and send you the forms that we use. Using the action plans gives us directives for treatments when students are in different phases of asthma attacks and will protect us as an order. If a medication is discontinued, I do want something from the MD, but will take a note from the parent in the mean time. I know I most likely won't get anything from the MD, but the parent note takes the liability off of me stopping the med without any directive from someone. I have it in writing. And I always ask the parent o document that the will get something from the MD. 

 

admin said its OK for all meds to be brought in on bus even controlled bc many students only transport available is bus  how do I document recieving this? I have no proof of them documenting it before from what I can see. mainly concerned about the controlled med.   

Absolutely NOT! No medications should be brought in by the student. Huge liability, especially for the controlled meds. If a student brings in a controlled med, I will count it out with my assistant, notify an administrator, call the parent, and will NOT administer it until the parent comes in and counts the meds with me. I am not going to be held liable for missing medications.

A student with adhd needs her meds brought in- I cant find evidence that last year there was a count sheet for this  should I print a generic one? should it go in her file when done? 

I have to count all controlled substances every Friday in the presence of may assistant. If she is not here, I must get another staff member to watch the count and co-sign. I am unable to accept more than a 30 day supply of any medication. 

** I sent you a private message .. Trying to give you a hand!!   Beachynurse

thank you all for your guidance!