OTC Meds

[Kafergie]

I know that here in Texas, public schools do not give OTC meds without MD auth, parent permission, etc. Below is a post I put on RNsights so I apologize for those who see it twice. I stepped into a private school nursing job several years ago and the parent annual OTC authorization was already in place. Looking to change it and needing ideas for backing up my decision in terms of liability for the school and my license, etc from private or public school nurses. Thoughts? Here is my original post:

"My private school has annually gotten a blanket permission signed by parents to authorize certain OTC meds as needed throughout the school year. Although it is nice to give a child who truly has a headache a dose of tylenol, I constantly feel as if I'm giving meds to kids who really don't need it. I am looking to make changes next school year and not keep a stock of the OTC meds for just anyone's use. Unfortuantely, our school parents see things such as this as a "perk" of private school and there will be a lot of resistance to making the change. I am in Texas and the state guidelines strongly discourage giving OTC meds unless they are brought in by the parent and is for a designated time frame. How does your private school handle this?"

[NutmeggeRN, BSN]

We give them in NH with parental written permission, using nursing judgement. I'm in HS and see the benefit of hitting a migraine early with ibuprofen or dealing with cramps etc. I also do a lot of fluid pushing and just resting to avoid the OTC but sometimes if that OTC is difference between them being dismissed or spending the day miserable, I am OK with that. I know others do not agree, just stating the allowable and acceptable practice where I am. They need to be in school and if I can assist with them staying and not missing academics then I'm all for it.

[hsnurse1]

I am also a HS nurse and in AR we are allowed to give OTC meds with written parental permission. I agree with nhnursie- if it is the difference between them staying in school or going home b/c of headache or cramps I have no problem with it.

[Kafergie]

Thank you! I agree that I don't want to do away with OTC meds altogether, just hoping to find some middle ground. If a child has regular migraines or has an ear infection and needs pain control a couple of days, I would like to have specific instructions with a time frame and permission from the parent. Currently, our parents sign a blanket auth to give all sorts of OTC meds, but only at the beginning of the year, good for the entire school year. That basically means I can give their child tylenol, etc even if they come 3x a week all year. Just trying to make it not so convenient for my frequent flyers to get out of class. I'm hoping to limit maybe how often I can give OTCs without an order from an MD, maybe? Just looking for ideas from others that I can maybe implement.

And yes, I have been here 7 years and it has bothered me more and more each year. Not sure why today I decided I needed to be concerned about liability. Maybe I'm just ready for summer break

[Flare, ASN, BSN]

I have been considering getting a blanket order for otcs from the school md, but my hesitancy has been for the exact reason you state. That the frequent flyers would start treating the office as their personal dispensary. My idea for that (mind you, i haven't actually inplemented any of this, so it's all just talk) was to put administration limits clearly defined on the parental siganture sheet. That should a student come into the office seeking an otc more than X times seeking an otc for a certain condition, that condition will be considered to be a recurring issue that requires follow up with the student's personal physician and an order for medication in school - that no further medications would be permitted under the standing order. (I hope i'm explaining this well...)

Of course this will undoubtedly cause the parent to argue with you when they fail to make the follow up appointment and little sally calls crying because she has a headache (for the 10th time or whatever limit is set) and you won't administer due to this policy. You can almost hear the parent calling you already and saying "I don't understand why you can't just give her another dose this time.":no: This has been the sole reason why I haven't acted and have left it as a regular order.

[100kids, BSN, RN]

I have a blanket OTC form and LOVE it! In my state it must be signed by both the parents and the physician. It allows me to really help some kids when a little something will make their day tolerabe instead of miserable. I provide some simple items (neosporin, bactine, aquafor, cough drops, sunscreen, etc) that are on this sheet but it states that if you want your child to have Tylenol, advil, benedryl and a few other things that the parent must provide it in original container. If your child takes any of those medicines in school that you provide you will get notification from me. I have 1 student that suffers from chronic headaches. I text her mom that she has received advil after she comes in for it and it is given. If it is for anything not regular then I will contact mom BEFORE I give it. i.e I had a student who fell and hit her lip, fat lip, cracked and swollen but she did not need to go home. It hurt though so I called mom and we decided to go ahead with advil for pain so she could remain in school. Another day I had a parent call me to tell me that their son had an ear infection that is being treated but I had the ability to give him pain meds if he came in to complain instead of mom dosing him just in case before school or having to keep him home. I have many frequent flyers but they are not a problem with this form and asking for medicine. It's one of the best thing I implemented since being here.

[Kafergie]

This is helpful and I am excited to start working on guidelines. Thanks!

[lpnbutterfly]

At my school, OTC meds must be provided by the parent in the original containers. With parent's permission they are good for ten days only. If they want it to be good for the entire year it will require a physician's note. After the ten days, they must come and pick up the meds or they will be disposed of. This prevents them from being able to say (after the ten days) "can you just giver her one more dose?"