Residential TX for kids, anyone?

marshadolce · Apr 6, 2007

Hi, to the nurse who wanted to know if anybody worked in residential behavioral centers for kids. I work in Virginia outside Richmond at a behavioral health center for kids 13-18 yrs old. I am the Staff Development director (and unofficial ADON). The regs are very different than hospitals or LTC. Its part psych and part detention. I love what I do even though I don't have direct interaction with the kids. The facility is small only 84 beds. The med pass is minimal. There are no IV's, no real health problems to speak of, but alot of general pediatrics, immunizations, injuries, asthma, that sort of thing. The one piece that might turn people off to working with this population is the occassional violence or potential for violence. The kid gets bad news from a therapist or from home and can go off quick. Our Mental Health techs are good and quick to react but sometimes accidents happen. Go ahead and ask your questions, I'm sure you'll some good reply's. We're out here--Marsha

RNOTODAY, BSN, RN · Apr 7, 2007

Hi, to the nurse who wanted to know if anybody worked in residential behavioral centers for kids. I work in Virginia outside Richmond at a behavioral health center for kids 13-18 yrs old. I am the Staff Development director (and unofficial ADON). The regs are very different than hospitals or LTC. Its part psych and part detention. I love what I do even though I don't have direct interaction with the kids. The facility is small only 84 beds. The med pass is minimal. There are no IV's, no real health problems to speak of, but alot of general pediatrics, immunizations, injuries, asthma, that sort of thing. The one piece that might turn people off to working with this population is the occassional violence or potential for violence. The kid gets bad news from a therapist or from home and can go off quick. Our Mental Health techs are good and quick to react but sometimes accidents happen. Go ahead and ask your questions, I'm sure you'll some good reply's. We're out here--Marsha

Oh, good... I was beginning to think nobody was out there!!

I have recently started working in one. My questions are based on how things are "supposed" to be done... For instance, do the nurses give out otc meds with no doctors order? Like, a tylenol for a headache, cough syrup for a cough, that sort of thing? Does the direct care staff consist of basically people with no skills, and giving out many medications with only 45 minutes of training? Does your facility have nursing in 24/7? Are your nurses "on call" after hours for free? How is the medication system? Do you 'recycle" meds? Let me explain this one...... We have a pharmacy in the community that handles all our kids meds... they come on cards with bubble packs over each dose... when there is a med change, they put the not needed med in the "med closet", and we use that again when the dr writes an order, for any other kid, to get them started on it right away instead of waiting for the pharmacy . We have hundreds of meds to choose from...Is this common practice? i mean, we have no onsite pharmacy, and they *are* all po meds, so why should we be so in a hurry to give the meds that we have to 'recycle" .. shouldnt all meds be wasted when no longer needed?..well.I realize thats alot, so I will stop here for now.....I have many more "issues"........thanks!!!

oh, btw, my facility is similar size to yours, 60 beds on various units, is a non profit agency.

allantiques4me · Apr 7, 2007

Hi!! I work in such a facility.I work with kids 5 to 16 years of age.I absolutely love it and hope to be there forever.We have three houses with 15 kids in them a peice.We have standing DRs. orders we follow.(REmember your nursing,you would never give meds without a DRs. order)We do not recycle our meds.Most of our tasks are minor wound and illnesses.along with immunizations ,just like you said and of course the upsetting issues that come from child abuse and neglect.Such as violence or lack of social skillsOverall I truly love my job.You can PM me if you want.

marshadolce · Apr 9, 2007

Hey RNOToday,

Re: your questions on OTC's, I would think that your state laws wouldn't allow you to dispense OTC's without and order UNLESS you possibly had some "Standing Orders" policy that would cover you. Yes, there are people with little skill working in most of these facilities. A lot of them come from Juvenile Justice and don't necessarily make the transition from Corrections to Psych very well, in my opinion. But in Virginia where I'm from they DO NOT pass meds. Some Assisted Living places and Independent living places may use med techs but I think in this state if you are designated a hospital only nurses pass meds. Also, my facility does have mandatory overtime, but I've never heard of any place where you work for free unless you're management. You may have to work over and still get your usual salary. Some places pay their management staff straight time to work over or a certain amt less than their salary hourly to stay over. But as for your meds, no, no, no. I'm sure that is not legal by any state's standards. Drugs given by order to any person must have that persons name, the drug and dose and schedule on the bubble pak, bottle, cassette, whatever. Hope this helps--Marshadolce

RNOTODAY, BSN, RN · Apr 11, 2007

Hey RNOToday,
Re: your questions on OTC's, I would think that your state laws wouldn't allow you to dispense OTC's without and order UNLESS you possibly had some "Standing Orders" policy that would cover you. Yes, there are people with little skill working in most of these facilities. A lot of them come from Juvenile Justice and don't necessarily make the transition from Corrections to Psych very well, in my opinion. But in Virginia where I'm from they DO NOT pass meds. Some Assisted Living places and Independent living places may use med techs but I think in this state if you are designated a hospital only nurses pass meds. Also, my facility does have mandatory overtime, but I've never heard of any place where you work for free unless you're management. You may have to work over and still get your usual salary. Some places pay their management staff straight time to work over or a certain amt less than their salary hourly to stay over. But as for your meds, no, no, no. I'm sure that is not legal by any state's standards. Drugs given by order to any person must have that persons name, the drug and dose and schedule on the bubble pak, bottle, cassette, whatever. Hope this helps--Marshadolce

HI, thanks for the response.... when I said "no skills" , I meant * no* skills, as in you only have to have a drivers license. None of the people who work there, I assure you, have ever been in corrections:lol2:

And, this place is most cetainly not a hospital. Its a "residential treatment facility"

They do write the kids name on the bubble pack (after blacking the previous name out) does this count? The dose is the same (or sometimes it will be half, and we write take 2 tabs on the pack, and on the mar)

And we have no standing orders.... How would that work? Could an md write a standing order for all residents, admitted to the facility?

marshadolce · Apr 12, 2007

RNOToday,

Your system totally baffles me. They mental health tech's here don't have any special training from the outside either, but they are expected to attend trainings here. As for the meds I still think your system is no where close to any kind of acceptable medication administration practice. Check with your board of pharmacy and your board of nursing in your state. You can do so anonymously, you don't have to tell them where you work. If you do let me know.

Marshadolce

DDRN4me · Apr 19, 2007

Dont know how i missed this thread!!! I am a nurse manager in a similar facility (88 beds in main residence and 2 group homes of 12 ) we have kids from age 5-17. Most are medically healthy although we do have 2 with diabetes...I just started 3 months ago and believe me my staff freak out with the diabetes issues. They are used to physically healthy kids.

we have a Medical Director on site , and also have a Pediatrician consult who signs our standing orders for meds such as tylenol, cold and cough syrups ,etc. He also visits weekly for PEs and sick visits etc. I have staff in house from 7 am -10 pm. We are currently developing an on call system and it is going over like a brick!Right now i take call 24/7, but dont really mind as i am paid very well.

When a med is dc'd we will save it in a double locked cabinet in case the MD restarts it . On a rare occaision we will borrow and pack for someone who has run out before the outside pharmacy can get a med to us ; but we will not start a med unless it is blister packed and we have had necessary labs done. hope this helps!!!

RNOTODAY, BSN, RN · Apr 21, 2007

Dont know how i missed this thread!!! I am a nurse manager in a similar facility (88 beds in main residence and 2 group homes of 12 ) we have kids from age 5-17. Most are medically healthy although we do have 2 with diabetes...I just started 3 months ago and believe me my staff freak out with the diabetes issues. They are used to physically healthy kids.
we have a Medical Director on site , and also have a Pediatrician consult who signs our standing orders for meds such as tylenol, cold and cough syrups ,etc. He also visits weekly for PEs and sick visits etc. I have staff in house from 7 am -10 pm. We are currently developing an on call system and it is going over like a brick!Right now i take call 24/7, but dont really mind as i am paid very well.
When a med is dc'd we will save it in a double locked cabinet in case the MD restarts it . On a rare occaision we will borrow and pack for someone who has run out before the outside pharmacy can get a med to us ; but we will not start a med unless it is blister packed and we have had necessary labs done. hope this helps!!!

Wow. We have none of that... just a psychiatrist (2).. we take the kids to a peds office in the community, take them to the community lab, dentist, etc. We have NO standing orders for the otc meds. I asked my director of nurses, she said the *consent* signed by the parent/guardian covers us for the otc meds. I asked if she was sure, she said yes. But I still dont think so, and I dont know where to find out. Does this sound right to you?

DDRN4me · Apr 22, 2007

RNOtoday,

It would depend on the specific wording on the consents. If there is not a line that states something like "administration of OTC medication such as" then i would not consider it informed consent. perhaps you could try to formulate a general standing order consent and suggest that it be added ? It would need to be approved by an MD, maybe one of your psychiatrists would be willing? it would certainly cover your collective azzez should a parent say that they didnt want a certain otc given or if there were ever an adverse reaction. Good luck and let me know if i can help you~~ Mary