Parent Faked Order?

[lifelearningrn, BSN, RN]

Good afternoon my SN friends. I'm curious how many of you have issues getting order clarification from MDs (or suspect a parent may have faked orders). Here is the history.

I have a 1st grader with a hx of migraines, ADHD and behavior issues. In the beginning of the school year, I had to call mom for fevers (2-3x) and migraine (1-2 times). One of the times she had a migraine mom asked if I could give her Tylenol. I explained not without a doctor's orders. Well, about 5 weeks ago, mom comes in first thing in the morning (while I was busy) and dropped off the filled out orders and pharmacy labeled ibuprofen (go give q6 -8hrs for fever). I didn't look at the orders until she left. The orders called for ibuprofen every 4 hours "if has fever". (This parent speaks Spainish only) So, I call the doctor's office on the order to clarify the order AND to ask for the order to read for headache because the way I see it, if a student has a fever, they need to go home, not get medicated and sent back to class. I was placed on hold for 20 minutes. I hang up and call back the next day, again put on hold. I have since sent three faxes for order clarification (since when do we give ibuprofen q4?)... anyway, I can not get the doctor to call back or fax back clarification.

Fast forward to this week. Student throws up in classroom, gets sent to clinic and has temp of 99.4. No, not a fever but student says she's been vomiting since last night and mom gave me medicine when she woke up. We call mom, who says, "she has orders for medication, I gave it to the nurse myself".... I go on to explain that the orders have never been verified by the MD and that while I am happy to medicate a headache (with PROPER orders) I will not medicate a fever (and vomiting) and send the child back to class. I also explained (through my translator) that a child with a fever needs to be picked up because of risk of child being contagious. Mom was peeved she had to pick up her kid.

Did I handle this wrong? What doctor orders medication for fever to be given at school? The mom also lied to the teacher and told her I had orders to give ADHD medications at school-- as far as I can tell (mom hasn't provided me any documentation or meds for anything other than "if has fever"), the child does not take ADHD medications..

Do y'all have trouble getting doctor's to respond to clarification or did mom fake the orders? I'm beginning to think she did.

[OldDude]

She did or somebody else did. No MD, NP, or PA would write for ibuprofen Q4 and/or to give for a fever at school. Remain firm. Wait for the confirmation, in writing, which you'll never get. You made the right call. And by the way, if it ever comes up, we share a border with Mexico and we don't accept prescriptions filled outside of the US.

[Farawyn]

She did or somebody else did. No MD, NP, or PA would write for ibuprofen Q4 and/or to give for a fever at school. Remain firm. Wait for the confirmation, in writing, which you'll never get. You made the right call. And by the way, if it ever comes up, we share a border with Mexico and we don't accept prescriptions filled outside of the US.

Boom.

[bugya90, ASN, BSN, LVN, RN]

I'm not a school nurse however I work in a family practice clinic and can speak to that end of it. I'm not sure why you're not getting through to anyone at the clinic which is unacceptable. Every fall I'm the one who preps all the paperwork for back to school and get the providers to sign off. To me this order was not written by a nurse or provider. Our orders are always wrote out correctly (Tylenol 500mg 1 po q8hr prn for headache greater than 3/10) and then signed by the provided and stamped with our clinic stamp that has our address fax and phone numbers. Honestly if it doesn't look right to you as a medical professional you have every right to question it. We've caught parents faking notes for all kinds of things (normally excuse notes).

[OldDude]

I'm not a school nurse however I work in a family practice clinic and can speak to that end of it. I'm not sure why you're not getting through to anyone at the clinic which is unacceptable. Every fall I'm the one who preps all the paperwork for back to school and get the providers to sign off. To me this order was not written by a nurse or provider. Our orders are always wrote out correctly (Tylenol 500mg 1 po q8hr prn for headache greater than 3/10) and then signed by the provided and stamped with our clinic stamp that has our address fax and phone numbers. Honestly if it doesn't look right to you as a medical professional you have every right to question it. We've caught parents faking notes for all kinds of things (normally excuse notes).

Boom ada Bing!!

[Farawyn]

Boom ada Bing!!

Dude.

[SnowyJ, RN]

The way an order is written usually gives the faker away.

A couple years back I had a parent go to the trouble of copying letterhead from a local urgent care and writing a note supposedly from the MD that the child could swim with ringworm. I wish I had saved it. Called the UC to confirm it was phony. BUSTED.

[OldDude]

I told you guys about my falsified immunization record. Hand drawn to look like a stamp on the wrong immunizations.

[Flare, ASN, BSN]

my esteemed colleagues have pretty much nailed it. a 20 minute wait on hold? that's insane - you have more patience than me. I would call back with my sweet but not so sweet voice and kindly let them know that i was placed on hold for an unacceptable amount of time last time and that i really need this matter cleared up.

the whole thing reeks of falsified documentation. I have never seen a pedi write for ibuprofen q4h.

[tining, BSN, RN]

Ask to speak with the office manager. Scan email order and send to her with the explanation. She should (hopefully) show to MD and get the validation you are seeking. I am perplexed at why parents do these things - like we just walked in off the street in our Wendy's uniform.

[Cattz, ADN]

This brings a question to my mind.

One of my Principals called the Physicians office to question the validity of an excuse for a student's medically excused absences. Mom blasted the Principal for this. Screamed the HIPPA violation mantra. I know that we can call to clarify medication orders. But, I am wondering where it is explained, in the event that I would have to reproduce it, that we can call to question this type of order. From the sounds of things, we all better get it tattooed on our arm for quick reference.

[OldDude]

I wouldn't think it would be any kind of violation if the office had issued the information, by written form, to the school and the school called to verify the information that had been addressed to them. The MD office verifies the information or doesn't verify the information. Nothing else is being discussed or disclosed.