Presentation for area Pediatric Offices

[k1p1ssk, BSN, RN]

Has anyone ever done a presentation for area pediatric offices to educate their staff on what school health office needs are? If you have, how did you go about arranging it? Was it an actual presentation, or more of hand-out/power point situation?

There is one particular office in my area that will send a "med order" that is in narrative form which, A) makes it hard to read and B) often leaves important and required information out.

Today, I received an order that read "Please dispence 1 benadryl at 1.30pm on 1/14/20 and 1/15/20"

I have so many issues with this... AND DISPENSE IS SPELLED INCORRECTLY! Honestly, I know the PA did not fax this herself, so I'm a little irritated that a nurse didn't check the order before forwarding it on to me (though I suppose a MA or receptionist could have been the one to do it).... But regardless, now I have to call back and say What Dose, What Route, What Reason....

I know that the practitioners at this office will get irritated if they have to sit through a presentation, but it frankly would be easier on everyone if they knew what we wanted ahead of time so that repeat phone calls and corrections to orders didn't have to be made.

[NutmeggeRN, BSN]

Powerpoint but keep the slide wordage to a minimum

Accurate and concise Rx

Emergency action plan for every MDI and Epi pen

A copy of your schools head injury policy ( I fight all the time with parents when the provider says "ok to return to play" when there is a 4-5 day process involved). They all take it as ready to go right back into action when it should be a day by day process.

These are just a few off the top of my head.

[LibraSunCNM, BSN, MSN, CNM]

The fact that you actually have to contact a medical provider's office and tell them "Please dispence 1 benadryl at 1.30pm on 1/14/20 and 1/15/20" is not an acceptable order is pretty mind-blowing. I feel like you can really tell these days which practices employ actual nurses and which rely on MAs/secretaries because they're too cheap to shell out for a nurse.

[ihavealltheice]

I feel like that was written by a secretary, not the doctor. Sigh...

Sometimes it helps if I give them a copy of my district medication orders. It's fill in the blank, so not much room to mess up.

[k1p1ssk, BSN, RN]

1 minute ago, ihavealltheice said:

I feel like that was written by a secretary, not the doctor. Sigh...

Sometimes it helps if I give them a copy of my district medication orders. It's fill in the blank, so not much room to mess up.

I know from experience working in an office that that is super annoying because they're also often difficult to read AND it creates an extra step as those offices with e-records need this scanned... If they create their own, it's automatically in the chart. I Just wish they'd realize it needs to have certain information....

[tining, BSN, RN]

Injury orders with out any information on how long to exclude from PE/recess.

Three different meds on one medication form.

Not giving parents an updated copy of Immunization record for known ages needing updates. Or, 6th grade student will need Tdap/MCV4 gets a flu shot and not boosters.

Only doing a blood sugar test for + acanthosis.

[bluebonnetrn, BSN, RN]

I think this is a fabulous idea. I am also frustrated with pedi offices in the area. You know that these kids likely go to this school district so it saves everyone time if you can provide what the district requires.

I have recently had TWO different pedi offices try to argue with me about what immunizations were required. I happily sent them a copy of the state requirements with the contested immus underlined, circled and starred! Like seriously... why am I having to explain that to you?

As far as the orders go... I usually write the order myself, fax it back with a note that says "Please sign these orders for Suzy Smith because the previous orders were written incorrectly" and include the copy of the erroneous orders.

[k1p1ssk, BSN, RN]

54 minutes ago, bluebonnetrn said:

I think this is a fabulous idea. I am also frustrated with pedi offices in the area. You know that these kids likely go to this school district so it saves everyone time if you can provide what the district requires.

I have recently had TWO different pedi offices try to argue with me about what immunizations were required. I happily sent them a copy of the state requirements with the contested immus underlined, circled and starred! Like seriously... why am I having to explain that to you?

As far as the orders go... I usually write the order myself, fax it back with a note that says "Please sign these orders for Suzy Smith because the previous orders were written incorrectly" and include the copy of the erroneous orders.

I like the fax back idea! Would hopefully save time on the phone.... Last year, I had a similar vaccine issue; In Mass, in pre-schools/daycares that are certified in Early Childhood Education through DESE, all staff must have had 2 doses of MMR (varicella is also recommended, but not mandatory) or titers to prove immunity. Out of the goodness of my heart, I contacted a physician's office for the teacher to get her immunization record or request that he order titers for her, and the doctor himself called me back questioning it. I explained it to him up and down, but his response was "WELL. In my 40 years as a practicing physician, I have NEVER heard of such a thing! Titers can be expensive! You can't possibly require people to pay out of pocket for that!" I had to take a deep breath and step back and I ended up just telling him I would fax him the law. The staff member let me know her blood work was being completed the next day.

[MrNurse(x2), ADN]

I don't think this would be beneficial. They know what the school districts require, they work exclusively with a school aged patient base, they just don't care. They will continue to push to see what will slide in an attempt to save time. The offer of an inservice would only be offensive, the only recourse is to continue to take time out of their busy days to fix their error. Kind of like the old days when doctors would scribble their orders and hope half of them could be deciphered.

[Flare, ASN, BSN]

i tend to agree -i think it would not be well received and if the local peds offices did attend your workshop or view your powerpoint (watch your ted talk, etc), it'd probably fall on deaf ears. I try to make my forms as idiot proof as possible. i mean they still get it wrong, but at least i can say that i tried ?

[k1p1ssk, BSN, RN]

35 minutes ago, MrNurse(x2) said:

I don't think this would be beneficial. They know what the school districts require, they work exclusively with a school aged patient base, they just don't care. They will continue to push to see what will slide in an attempt to save time. The offer of an inservice would only be offensive, the only recourse is to continue to take time out of their busy days to fix their error. Kind of like the old days when doctors would scribble their orders and hope half of them could be deciphered.

Clearly, the docs don't know. If they did, the ONLY reason they would have to not do it right the first time would be out of pure hostility, which doesn't make sense. Why would they actively want to make it harder on everyone?

The specific office I'm wondering about is actually primarily an adult practice that just happens to have some pediatric patients... The problems most usually arise when the kids go for an urgent visit and see a practitioner who isn't used to seeing kids on a regular basis.

I'm almost wondering if I go to the admin or nursing supervisor at the office first and give the whole idea in an effort to make their practice more efficient. How many phone calls will be eliminated if they just do it right the first time? It would be incredibly easy if they built templates into their charting system... Then it becomes fill in the blank. In my experience, having worked for many years in two different offices, the doc gives a VO to the nurses/MAs, who in turn are the ones who actually write it up, and then send it to the doc to electronically sign.

[Mango Juice]

I think this is a good idea. The only thing stopping me from doing something similar is taking comfort in the fact that I probably do things that do not make sense to them. I will let them make the first move :)