Admin just not getting it

  1. We have went over and over how we need to revise the medication administration policy before next year. In my state the RNs can not dispense OTC meds without a Dr. order. But of course we are asked to do it everyday. The current policy is "Prescription meds in pharmacy bottle with label and authorization note from parent." Which that is fine. The OTC part is stupid and redundant "The parent must give consent for their child to have OTC meds such as Tylenol or IBU that they will supply to the school. The school does will not supply OTC meds." Well hello if I provide a bottle of Tylenol for my child then yes I am giving permission for them to have it. But the teachers do not want to give any meds. The expect me or the other nurse to give it all. We cant give OTCs I have screamed this till I am blue in the face. No we have no medical director and no standing orders either. And after asking for a meeting to review policies and getting no response to that I get an email asking me to read this and see if I agree with it. Um NO it addresses nothing! And NO the students may NOT bring any medication to school! I am about to curse! And of course it says nothing new about OTC meds.

    Student Medication
    Students who need to take medication during the school day should bring their medications with a note that is dated and signed by the parent with instructions as to how the medication should be given to the school office. The medication must be in the student's name if prescribed by a doctor. If the medication is over the counter, the medication must be in the original packaging with dispensing information. Each school should have a designated person to administer the medication to students. That individual shall be trained by the district nurse on the proper procedures to be followed when administering medication to students. Refer to full policy in the student handbook.
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    About ABRN2012, ADN

    Joined: Nov '17; Posts: 96; Likes: 337

    19 Comments

  3. by   OldDude
    You've probably done this but...print the section of your Nurse Practice Act which prohibits you from administering OTC meds without a MD order. This prohibition would also include you being prohibited to delegate a task your are not allowed to perform to someone else. Training someone to administer an OTC med is delegating a task. If they want to delegate someone to keep and administer the OTC meds then do it but it can no way be attached to you or your nurse duties on campus...the end. You have no choice.
  4. by   NutmeggeRN
    Develop a form for MD signature and when that comes back, you are all set...easy peasy...(sarcasm)

    Seriously, every different iteration of OTC will have you swamped!
  5. by   ruby_jane
    So school is not considered "an extension of the home environment?" Meaning you cannot accept parental signature for OTC meds? OK, then. You're stuck, but you're better off being stuck since you have the NPA to back you up.

    Old Dude is (as usual) spot-on here....if you can't dose, you can't delegate (so the parent would need to delegate to the teacher).
  6. by   ABRN2012
    See thats why I come here and vent. Cause yall get it and I feel like I scream it all the time here and everyone just looks at me crazy. They even say "thats just stupid a nurse cant give a Tylenol but a teacher can." Yep its crazy but that the way it is.
  7. by   ruby_jane
    Quote from ABRN2012
    Cause yall get it and I feel like I scream it all the time here and everyone just looks at me crazy. They even say "thats just stupid a nurse cant give a Tylenol but a teacher can." Yep its crazy but that the way it is.
    WE GET IT!

    The administrator could spend a few (thousand) bucks and get you a set of doctors' orders to administer the Tylenol, ibuprofen, aleve, what have you....

    Weirdest thing - summer camp is definitely NOT an extension of the home environment. We have to have MD signature to administer OTCs. The parents never get it - "You mean I have to go to my kid's doctor for a prescription for Tylenol???"
  8. by   Flare
    i don't know what state you're in, in my state no medication can be given except by the nurse (except the medications that can be delegated - i'll get to that in a moment)
    All medications - OTC or RX require an order from an MD, DO, APN. No supplements are permitted - must have FDA approval. I can't even give a cough drop out without an order per the letter of our law.

    I can delegate Epipens, glucagon, and most recently (via a memo from DOE )narcan - though the language they use i am not so sure if it would be considered ME delegating administration of narcan.
    Students can carry and self administer epipens, inhalers and insulin or their orders are written as such. They are not permitted to transport anything else to school. Granted, this does not deter them from bringing me bottles and order sheets or even the occasional mystery pill that they are supposed to take at 10 am (gotta love it!)

    I could get a bunch of standing orders for otcs, i've seen it done in plenty of districts around here - i've debated it with our school MD and we both decided it was in out best interest not to do so.
  9. by   JenTheSchoolRN
    Quote from ruby_jane
    WE GET IT!

    The administrator could spend a few (thousand) bucks and get you a set of doctors' orders to administer the Tylenol, ibuprofen, aleve, what have you....
    THIS. It took me two years, but my last boss got it. Realized that a school physician's job does feel like signing paperwork and not much else, but that paperwork is worth its weight in gold. I talked up school guidelines.

    They listened and no this a line item per my budget. It is a pretty expensive one, but necessary! We get OTC orders signed, standing order Epi. Also when we had a student with a potential crisis on an out of country field trip, we called the school physician to consult, which again worth its weight in gold. Parents also love that we have one.

    Of course, they can be hard to find. And the malpractice insurance coverage part is a beast (I did a LOT of legwork for my school when we needed to hire one and pay for it vs. using a person that was on the school board previously, learned a ton about it - more than I will ever need to know).

    But hugs. When admin doesn't listen it is hard. Just get those guidelines. If you are in a public school talk about your department of education. Do they give you a health grant? Do they audit your office? If they haven't, but have audited SPED, you can say something like "what happens if they audit us and we're not following state guidelines?"
    Last edit by JenTheSchoolRN on Apr 13
  10. by   ABRN2012
    Ive printed every other school around my area and in my states med policies and they all follow the laws. Has to have a physicians order! Of course my district is the only one that isnt in compliance. Nurses and some staff have tried every year to get it changed but to no avail it still stands that you can send a bottle of tylenol or ibuprofen ect with your childs name on it and sign a paper and they can dish LD one everytime they want one. But thats not legal. Ive printed out what DOE states and what my BON states and if I have to I will go in front of the school board to get this changed. And if it doesnt get changed Ive decided that I will type up a statement saying I do not agree with it and will not be held responsible for what they do and have the sup sign it. If they dont like it they can find a nurse who doesnt care to lose their license. They are so scared these parents will get mad if they dont give LD a tylenol everytime they whine about a headache. So what they are not dying and if they need it that badly the parents can get an order!
  11. by   WineRN
    Quote from ABRN2012
    if they need it that badly the parents can get an order!
    THIS!!

    Some of my parents hem and haw but I remind them that their pediatrician will understand what you need as soon as you call and you most likely won't have to bring your child in.
  12. by   ABRN2012
    Quote from WineRN
    THIS!!

    Some of my parents hem and haw but I remind them that their pediatrician will understand what you need as soon as you call and you most likely won't have to bring your child in.
    And if they dont have a physician for their child then we do not need to be "blanket treating" a could be serious health condition by dealing out OTC meds every other day.
  13. by   Katillac
    Maybe tell them that as much as you know they would never hire a person without the appropriate qualifications to teach just because the parents wanted that person hired, you expect them not to put the school and your license at risk because the parents want you to give OTC meds without an order.
  14. by   kidzcare
    "Nursing tasks commonly performed in the home setting by a parent/guardian or caregiver take on a more complex dimension in the school setting. Often parents/guardians and school administrators are confused about why what appears to be a simple task is held to a much different and higher standard at school. One of the challenges to delegation in the school setting is that parents/guardians and school administrators may not recognize that there is a requirement for medical orders for any health-related procedures in the school setting and that nurses are held to a higher protocol standard than a parent/guardian would be when delivering the same procedure at home. The school nurse practices in the educational setting where nurses support the primary purpose of providing education and must comply with state and federal mandates, nursing licensure standards and meet the expectations of parents/guardians, while working to ensure the health and safety of all students."

    From the National Association of School Nurses position statement on delegating tasks: Delegation, Nursing Delegation to Unlicensed Assistive Personnel in the School Setting - National Association of School Nurses

    Here is the position statement on Medication Administration as well: Medication Administration in the School Setting - National Association of School Nurses

    It's so frustrating to me that we are the only medical professionals in the building and even when we conclusively show what the law and/or best practice is, we are overruled. Why hire a medical professional if not to utilize their expertise?

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