Parent Faked Order?

[lifelearningrn]

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.

[NutmeggeRN, BSN]

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.

Just yesterday, for the first time ever, I got a note form an MD office that had this at the bottom of the note

***This is a legal document and cannot be tampered with. Schools are authorized to verify all information and do so accordingly

I thought that was pretty cool

[Cattz, ADN]

Wonderful. I have seen on a few of them lately that has said to "call if you have any questions"...or something to that effect.

I agree, it is a no brainer to me that we should be able to call. But, you know how parents are, when push comes to shove, if it can't be proven in black and white. There is no way to win. Sometimes there is no win, even when it can be proven in black and white.

[SchoolNurseTXstyle]

You did everything right. It is mandated by our practice that we ensure all medication is given properly and we have correct orders.

Even if student technically did not have fever, she did have vomiting. Any way you look at it, med order or no med order - she needed to be excluded!

[bugya90, ASN, BSN, LVN, RN]

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.

When schools call us to confirm a note we just confirm that yes that did come from our office and the excused dates are in fact correct. Our notes are pretty standard and say please excuse Susie for date-date. She may return to school on date with no restrictions (or list the restrictions if there are any) and then signed and stamped. It's not a HIPAA violation cause we are just confirming that yes that document is valid. Now if they ask for a diagnosis of why Susie missed school then there would be HIPAA issues involved and we would have to get parental permission before releasing that info.

[Cattz, ADN]

When schools call us to confirm a note we just confirm that yes that did come from our office and the excused dates are in fact correct. Our notes are pretty standard and say please excuse Susie for date-date. She may return to school on date with no restrictions (or list the restrictions if there are any) and then signed and stamped. It's not a HIPAA violation cause we are just confirming that yes that document is valid. Now if they ask for a diagnosis of why Susie missed school then there would be HIPAA issues involved and we would have to get parental permission before releasing that info.

Thank you bugya. That is very valuable perspective. I appreciate your input. I am tucking this away for future reference.

[Angelicpurl]

I got blasted HIPPA violation because I called MD office to clarify med orders and I was providing home health to the pediatric patient. I also love when I call & the MD office says they'll call me back after they contact mom & verify it's ok to give me the information. Wth?

[JustBeachyNurse, LPN]

Verification of orders and communication is specifically allowed in HIPAA. It's not a HIPAA violation for a nurse involved in a child's care to validate orders whether a school, private duty or hospital nurse

[Angelicpurl]

Yep. Hence why my boss said, "***" when she hung up from the call. I just happened to be there & heard the mom screaming she wanted me fired for it.

[MrNurse(x2), ADN]

Verification of orders and communication is specifically allowed in HIPAA. It's not a HIPAA violation for a nurse involved in a child's care to validate orders whether a school, private duty or hospital nurse

Excellent example of how regulation creates a minefield of ridiculousness. People really don't know what it all means.

[bell1962]

I am a school nurse and I work in a family practice clinic. this is right on!

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).

[DarkEyed]

I think you handled it the right way. There is definitely something strange with all of that...

[Kate1RN]

Fever is not a diagnosis so the order is wrong to begin with. I have had kids with seizure DO that can get meds for a fever over such and such. Also kids with sickle cell that can get meds for fever but the diagnosis can't be fever. Th order ia incomplete. You are completely right.