OTC Meds Given Without Written Consent

[Reneec]

New school nurse in small public elementary. There seems to be some cliques of staff/parents/community that "have each others backs". As an outsider, I don't know who is tied in with whom at this point. I ran into a situation that I would like some advice on. 
A 4th grade student came to the clinic with complaints of sore throat. She had a note from her teacher stating that I had her medication in the clinic. The only medication/ consent form I had for this student was for epi pen. I tried some comfort measures and sent the student back to class. I informed the teacher that I had no OTC consent. Teacher called parent. Parent called me requesting Ibuprofen be given for anxiety. Parent says they have been giving her Ibuprofen for anxiety and it has been helpful. I instructed mom to complete medication consent and send medication to school ( per policy). About 30 minutes later, student returned to clinic saying she went to the secretary to get her medication but it was a sub so the the sent her to me. The sub secretary told this student that if I couldn't find her medication, that she would call the FT secretary to find out how to get it. Again I explained that I can't give medication without consent. Later, I tried to followed up with the student and the teacher said "everything is fine now". 
I suspect that someone gave this girl Ibuprofen but don't know who. Nor do I have proof. That being said, if OTC meds are being given by non certified staff, do I have any liability? Am I making too much out of the situation? I'm worried about students being given a medication that I am not aware of. Any advice is appreciated.

[lifelearningrn, BSN, RN]

I wouldn't give ibuprofen for anxiety.. I've never heard that. Sounds like mom gives medication for a placebo effect when child doesn't feel well or has a complaint?  

Even with standing orders, Ibuprofen to alleviate anxiety wouldn't be a standard, I don't think.  

If staff gave medication without your signing them off and authorizing it, I can't see how that can come back on you. 

[NutmeggeRN, BSN]

I would document your concerns with administration. Research your state NPA and your local school district policy so you have policy to stand on

[Cattz, ADN]

Your best bet is to see exactly what the school Policy. If that isn't being followed- document clearly when you talk to Admin and whoever else. In Missouri we have a Training that we give anyone that we delegate medication administration to. Or that even might be in the position to give meds when the nurse isn't available. If your state doesn't have a designated training for this purpose. I encourage you to use ours from Missouri or at least use it as a guide if it doesn't fit your state's guidelines.

Here is the link- https://health.mo.gov/living/families/schoolhealth/office-management.php

Click on Guides and Manuals. On that list- "Medication Administration in Missouri Schools: Guidelines for Training School Personnel" Under that there is a Power Point-"Medication Administration Training"

I work in a small, rural school and understand how that all works when everyone knows everyone else.  But, no one (or at least very few)  understands how it is to be the Nurse in the building and that we have a License to protect.

Your question is very legitimate and you are working really hard to cover your bases.

Good luck and please let us know how this is going.

 

[k1p1ssk, BSN, RN]

This is all around insane to me - has there never been a nurse in the building before? I could maybe sorta understand it if they were new to having a medical professional working with them, but even so... Ibuprofen for anxiety?? What planet do they live on? 

I would document everything you wrote in your post and bring your concerns to admin. Then, figure out if you have standing orders for OTCs. If you do - what does it say it is OK to give Ibuprofen for? My guess is that it is for fever and pain. If the parent is asking you to give it for anxiety, I would push back and ask them to provide MD orders specifically for their student to justify giving the med. 

Also, I second the above - find our your school/district's medication policy. Maybe you (or admin) need to send out an email reminder to all staff that medication should not be administered by anyone but the nurse unless it is directly delegated by the nurse. 

[BlondieRN19]

I could have written this post myself!  I am the first school nurse ever in my district.  Secretaries and Administrators have been providing medications to students "for years" without proper authorizations despite a district-wide policy that reviews the state laws and mandates written authorizations.  I spoke with superintendent and our state Nurse Consultant to no avail.  I have always had my own malpractice insurance, and I provided a Medication Administration training to secretaries at the start of the year.  I had them sign in and provided a "certificate of completion".  They were given the necessary information along with hand-outs to keep for reference.  They continue to do what they want and it is so frustrating to me.  I saw a secretary take medication out of her purse and give to a student.  I always hear the same excuse "But I know the family and the parent doesn't mind".  I'm sorry you are dealing with this situation but glad to know I am not alone.