No Meds, No School

[UrbanHealthRN, BSN, RN]

As part of my ongoing efforts to improve student health services, question for you all:

What do you do with kids who are 1) known to have a medical condition that requires emergency meds (ex. allergies, asthma, and seizures), or 2) a medical condition for which the doctor has ordered meds at school, and the family doesn't provide you with those meds?

More specifically, is the kid allowed to keep coming to school while you try a million different ways to get the med, or does the kid have to stay home until it's brought in? My state doesn't provide guidance in regards to excluding vs. not excluding, and I'm wondering what other districts do. I have some thoughts of my own about this, but am curious to see what you all say.

[nursekoll, BSN, RN]

I feel like these are all unique situations and should be handled uniquely. I struggle to get asthma meds kept at school, but the students still attend. My state has a law that allows a Dr standing order for Albuterol neb and epinephrine in emergency situations for students that have no individual plan. I keep trying to get their own meds and plan, but that standing order and EMS is my fallback for these kids. For diagnosed diabetics that come without appropriate meds, I call home and will send them home if no meds are brought in. This is an exclusion under the nurse's discretion that the student would not be safe to be at school due to lack of necessary supplies ordered by a Dr. If you have a Dr order and diagnosis. If it's just heresay that the student has XYZ diagnosis and uses ABC medications, then more investigation is warranted in the form of release from parent so you can contact the Dr directly. Get your administration involved if needed, for the safety of these students.

Also, I have called CPS regarding parental neglect in providing students with needed medications and medical treatment. So that's another option if you can't get though any other way.

[AdobeRN]

1. Make reasonable attempts to get the desired medication for school use, but if parent refuses/ignores etc there is not much we can do except have 911 on speed dial. My district does provide emergency Epipens and Albuterol for campus use - so I feel if a parent doesn't want to provide their own at least I have something so I tend not to worry about these situations to much.

2. I don't think there is anything you can do in this case either except have 911 on speed dial; maybe alert your local FD about the kiddo - the fire captain comes to our campus' every year at the beginning - we let him know about any medically fragile kids/DNR kids etc we have incase anything happens. Besides diabetics seizure kids what other medical condition would have doctor ordered meds that would be required for student to attend school??

[UrbanHealthRN, BSN, RN]

Besides diabetics seizure kids what other medical condition would have doctor ordered meds that would be required for student to attend school??

I'm not sure what those other conditions might be, but in case they're out there, I wanted to include them!

This is an exclusion under the nurse's discretion that the student would not be safe to be at school due to lack of necessary supplies ordered by a Dr. If you have a Dr order and diagnosis. If it's just heresay that the student has XYZ diagnosis and uses ABC medications, then more investigation is warranted in the form of release from parent so you can contact the Dr directly. Get your administration involved if needed, for the safety of these students.

This part of the problem I've been facing since starting this job. I feel like staff (who are not me) have been quick to try to exclude kids because of lack of so-called "emergency meds". I say "so-called" because these meds are only parent-reported, and I have no MD documentation stating they need to be kept at school. Staff tell me this has been my program's policy for two reasons: 1) exclusion is sometimes the only way we can get a parent to bring a med in (100% true); 2) by not having the med on-site for the student, staff claim we are somehow depriving the student of a necessary accommodation for their safety and well-being, so we have to exclude them until the accommodation is made. Ok, I can sort of see what they're trying to say, but some kids are missing days worth of school, sometimes just for an inhaler that they used once a year and a half ago! Besides, it's totally on the parent, not us, that this is happening with the kid.

Unless it's an epi-pen, or albuterol for a severe asthmatic, I'd like to give some families more leeway with bringing in the med before excluding. Like reminder phone calls, warning them about calling 911 if we have no meds available to give the child, etc. I just hate to see kids miss school. I guess I was wondering if anyone else finds my program's rationale a little extreme.

[nursekoll, BSN, RN]

This part of the problem I've been facing since starting this job. I feel like staff (who are not me) have been quick to try to exclude kids because of lack of so-called "emergency meds".

Unless it's an epi-pen, or albuterol for a severe asthmatic, I'd like to give some families more leeway with bringing in the med before excluding. Like reminder phone calls, warning them about calling 911 if we have no meds available to give the child, etc. I just hate to see kids miss school. I guess I was wondering if anyone else finds my program's rationale a little extreme.

Extreme in the opposite way that my school is extreme- letting kids stay even when they haven't followed the legal requirements such as immunizations, physicals, etc or parents just ignore all calls and keep sending their kids to school no matter what.

Are the parents upset when their kid is excluded? Around here it seems parents and admin want kids in attendance under nearly all circumstances.

[UrbanHealthRN, BSN, RN]

Extreme in the opposite way that my school is extreme- letting kids stay even when they haven't followed the legal requirements such as immunizations, physicals, etc or parents just ignore all calls and keep sending their kids to school no matter what.

Are the parents upset when their kid is excluded? Around here it seems parents and admin want kids in attendance under nearly all circumstances.

If it's related to a legal requirement, I don't know why any school would let kids keep attending if they're in violation. Once again, common sense...gone out the window...there it goes....

Some parents could probably care less about exclusion, but for others it's stressful to have their kids excluded, because it's absences that count against their attendance, they have to arrange for childcare, etc.

[ruby_jane, BSN, RN]

It's not like vaccines, where we can legally exclude them from school. We are obligated to provide a free and appropriate public education.

I feel your frustration, Urban. I try to make it less convenient for the parent NOT to provide me the medication. If parent has not provided an inhaler and the kid needs an inhaler, parent has to pick that kid up. Parent not available and kid worsening? EMS is my only option. Every year I don't have what I need for a few students. Every year I say the above to the parents who cannot or will not provide the medication. Good luck!

[BrisketRN, BSN, RN]

I've only ever dealt with this with Epi-Pens. I have stock Epi-Pens, but recently (thanks to this shortage) our Epi-Pen Jrs expired, and we are without back-ups. Some students come with only one Epi-Pen (especially this year with the shortage) and keep it on them/in the classroom but at times it ends up in back packs, at home, left in the car, etc. I emailed parents and let them know that now, since there are no back ups, if their child does come in contact with the allergen OR is showing ANY sign of allergic reaction we will be calling 9-1-1 immediately if we do not have an Epi-Pen for them. Per our school paperwork all emergency services are billed to the parent. It was shocking how quickly Epi-pens appeared in my office.

[UrbanHealthRN, BSN, RN]

One piece of communication that seems to have been missing with my program is telling parents about calling 911 in the event that we don't have the meds available to help their kid. From a few conversations I've had with coworkers, for one reason or another, they either didn't consider 911 to be an option, or had some sort of legal concern related to it, so we've jumped to automatically excluding kids as soon as we hear about a medication and don't see them bringing it in. Again, that has translated to literally hearing about a med in the afternoon and then not allowing the kid to enter school the next morning because the parent worked late and hadn't picked up a refill yet. And I can't prove it, but I think seeing that happen makes some parents afraid to tell us about their kid's medical issues for fear of exclusion, which isn't right.

Based on what's been shared on this thread, I think I'm going to talk to my director about modifying our exclusion policy just a teeny bit. It sounds like there's definitely a place for excluding, like with families who needs fires lit under their bums before they do anything, and so I don't want that to go away. But for other families, maybe telling me about what's going on (gee, who woulda thunk!) and having me make a plan with families around meds for their child will help get meds into school without having to kick kids out.

Once again, reasonable nurses for the win!