Meds Not Needed At School

[UrbanHealthRN, BSN, RN]

Just had the tidal wave of pre-K kiddos come back over the past week. I'm sorting through my PEs and health histories, and I'm getting meds set up, and something that's really been bugging me is the kids who have meds ordered for school by their doctors vs. the kids who don't.

It's rare to see a true asthma diagnosis in this age group, but we've got plenty of wheezers. And doctors will note asthma and wheezing on school PE forms, but then half the time say no meds are needed at school on those forms. Ok, but then what do I do when a kid starts wheezing out of nowhere? I can only enforce meds at school if the doctor orders it, and for everyone else, I tell parents that it'll be either a call to them or 911 if I don't have meds available. That inspires some parents to bring meds in, but other kids still don't have any here. The same goes for "food allergies"- most kids do have epi-pens ordered, but some doctors actually list food allergies on the school PE form and then say no meds are needed at school.

Living life on the edge can be fun from time to time, but I'm not liking it when it comes to keeping these little beans safe! And I know that in the end, I can call doctors' offices if I have any questions about keeping meds here. It just feels like such a drain on my time when the doctor could have just respected the need for safety in the first place and listed meds on the PE form.

[JenTheSchoolRN, BSN, RN]

Do you have a school physician? Mine wrote me orders for standing Epi. Now, instead of requiring students to bring in their own Epi-pen, I just use my standing epi for students that need it for both diagnosed and undiagnosed severe allergic reactions (and my orders say so as well). It has made my life so. much. easier. Parents love it as well.

I do still ran after parents for a field trip Epi-pen, but that does give me some time and breathing room.

[UrbanHealthRN, BSN, RN]

Do you have a school physician? Mine wrote me orders for standing Epi. Now, instead of requiring students to bring in their own Epi-pen, I just use my standing epi for students that need it for both diagnosed and undiagnosed severe allergic reactions (and my orders say so as well). It has made my life so. much. easier. Parents love it as well.

I do still ran after parents for a field trip Epi-pen, but that does give me some time and breathing room.

We don't have a school physician, and I'm not sure if that's doable here, but since a lot of our kids all go the same health center for primary care, I'm wondering if I'll be able to work something out with one of the providers.

In the meantime, it's just very piece-by-piece, trying to see if providers will fill out a medication form.

It's scary too, because just yesterday I had to have a mom urgently pick up her child who was wheezing, having difficulty breathing, and had no albuterol available at school to give. The doctor didn't indicate on the physical that this was a problem or that meds were needed. Looks like that might change, because mom's scheduling a follow-up appointment with the doctor to figure this out.

[SaltineQueen]

Does your state allow you to stock emergency albuterol & Epi (and I guess narcan, depending on your age group)? A local doctor, who acts as the team doctor for high school sports, writes the orders for us. We get the Epi through the EpiPens for schools program, and I'm pretty sure we pay for the others ourselves.

[nursekoll, BSN, RN]

It's scary too, because just yesterday I had to have a mom urgently pick up her child who was wheezing, having difficulty breathing, and had no albuterol available at school to give. The doctor didn't indicate on the physical that this was a problem or that meds were needed. Looks like that might change, because mom's scheduling a follow-up appointment with the doctor to figure this out.

In my state, we have standing orders for epi-pens and albuterol nebs specifically for students, staff, or visitors with unknown issues or when their own plan or meds fail. You might check on this with your state school nurse consultant or local medical providers. It's good to be prepared for these emergences!

[MrNurse(x2), ADN]

We don't have a school physician, and I'm not sure if that's doable here, but since a lot of our kids all go the same health center for primary care, I'm wondering if I'll be able to work something out with one of the providers.

In the meantime, it's just very piece-by-piece, trying to see if providers will fill out a medication form.

It's scary too, because just yesterday I had to have a mom urgently pick up her child who was wheezing, having difficulty breathing, and had no albuterol available at school to give. The doctor didn't indicate on the physical that this was a problem or that meds were needed. Looks like that might change, because mom's scheduling a follow-up appointment with the doctor to figure this out.

It seems that you are at a private school. Check with your health department, they may be able to provide medical oversight and prescriptions. You may want to check state law, too. Maryland allows epipens without prescription via order from the state surgeon general. Stock inhalers are expensive, that is why we don't have them. For students who are ordered them but I don't have one, I send an email saying EMS is ten minutes away and the brain survives four minutes without oxygen. I can only provide the care I can with the equipment I have, so please equip me to give the best care.