Ridiculous things. This is a new one one me.

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Have any of you EVER had dr. orders to give Ritalin 3 times a day at school? To be exact--- before breakfast and lunch (7:45 and 11:45) and at 2:30? I am still shaking my head on this one. :no: :sarcastic: Just to explain a little further-- the 2:30 dose is at motherdearests' request so the kids aren't sooooo wild and crazy when they get home!!! pullleeeeez

Specializes in Adult Internal Medicine.
I would definitely be concerned at the idea of giving 3 doses of Ritalin in such a short period of time.

Out of curiosity, why?

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Out of curiosity, why?

3 doses in 6 hours? I've read up on it since you've posted, and that still seems close.

I would at least question it, like Cattz did.

Am I totally wrong here? I can take it if I am.

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Specializes in Adult Internal Medicine.
3 doses in 6 hours? I've read up on it since you've posted, and that still seems close.

I would at least question it, like Cattz did.

Am I totally wrong here? I can take it if I am.

Remember you can't just divide 6 hours by 3 doses. And it's really 6 hours 45 minutes.

If dosed at 7:45, 11:45, and 14:30 that's 4 hours between first dose and second dose and then 2 hours 45 minutes between second dose and third dose. For a medication with a duration of action of 3-5 hours. It's not all that unreasonable to me...

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Remember you can't just divide 6 hours by 3 doses. And it's really 6 hours 45 minutes.

If dosed at 7:45, 11:45, and 14:30 that's 4 hours between first dose and second dose and then 3 hours 45 minutes between second dose and third dose. For a medication with a duration of action of 3-5 hours. It's not all that unreasonable to me...

Gotcha. Would you expect us to question it if you prescribed like that?

(Nice ellipses.)

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Specializes in Pediatrics Retired.
Out of curiosity, why?

Of course this may raise another stink but another reason we "question" such deviations from what we normally see is to confirm the prescriber is actually aware of the order. I have run across many pieces of paper with electronic provider signatures that, come to find out, were not generated by the provider.

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Specializes in School nursing.
Out of curiosity, why?

Appetite issues for me. I have few kids with morning (given at home after breakfast) doses and than an afternoon dose after lunch. Even with those instructions of after lunch to help with appetite, getting those kids to eat more than 3 bites of anything is hard. And eating at home is also being affected. Kids have frequent headaches - finally found a way to get one kid to drink a protein shake at school consistently, still trying with others.

Yet, the med is effective everywhere else. Tough call, I know.

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Out of curiosity, why?

Because it is a deviation from the norm. I've seen Norco prescribed Q3 hours and called the physician to verify because I know the standard is q4 or q6. Because nurses do the actual administering of mediation, they are the last line of defense to prevent a med error or unsafe dose. Due diligence.

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Specializes in school nursing, ortho, trauma.

OD brings up a really good point. There have been times that a parent had gotten ahold of doctor's office paperwork and altered it or just downright forged a doctor's order to suit their needs. I am not saying this is the case here. You know, waaaay back in the day when i was just a little spark in nursing school my instructor told me never to hesitate to "confirm" any orders that seemed amiss to me. That didn't mean to bug the doc about the entire medex - "use your head, young Flare" she'd say. "but if you see that a patient is getting prescribed a medication that there is a contraindication or that the dosage can't possibly be right, don't be afraid to speak up."

This could have been one of those times that a parent did their own creative paperwork... given that this same doctor is said to have written a note to allow another student to have mountain dew to control their ADHD, I genuinely doubt it.

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Specializes in Pediatrics Retired.

I realized one of the local pediatric office clerical staff had gotten into the practice of generating school excuses, some complete with PE restrictions, all electronically signed by the provider, without the provider's knowledge. I work pool with some of the providers at Urgent Care and I brought up my suspicions to them. Sometime later I called the same office and there were different clerks working there.

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I realized one of the local pediatric office clerical staff had gotten into the practice of generating school excuses, some complete with PE restrictions, all electronically signed by the provider, without the provider's knowledge. I work pool with some of the providers at Urgent Care and I brought up my suspicions to them. Sometime later I called the same office and there were different clerks working there.

Badass.

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Specializes in Adult Internal Medicine.

Calling to verify that a order is correct is fine, and often appreciated. I am not sure that's what the initial post was about though. I don't think having concern is a "bad thing", don't get me wrong, I would be happy if someone called and verified it, or if a med was held due to concern for an adverse effect.

I do think there is a lot of bias when dealing with these type of medications, which I don't feel is appropriate from members of the health care team. For example, do you have the same concerns about dosing insulin at breakfast and at lunch? There is a stigma about mental health in general, and IMHO, a stigma on the parents of children with ADHD.

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Calling to verify that a order is correct is fine, and often appreciated. I am not sure that's what the initial post was about though. I don't think having concern is a "bad thing", don't get me wrong, I would be happy if someone called and verified it, or if a med was held due to concern for an adverse effect.

I do think there is a lot of bias when dealing with these type of medications, which I don't feel is appropriate from members of the health care team. For example, do you have the same concerns about dosing insulin at breakfast and at lunch? There is a stigma about mental health in general, and IMHO, a stigma on the parents of children with ADHD.

That's a fair point.

Again, all my kids are "self serve", so to speak, so no.

I would say-we see so many NON medicated kids out there, that a kid being on Ritalin or something of that ilk is usually more welcomed than not.

(I can't speak for Cattz, of course.)

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