Xanax in school?

mc3, ASN, RN · Nov 3, 2011

Gee, I haven't run into that one...I'd sure feel uncomfortable with it also. What if you're not there...who would decide that the anxiety would be enough to give medication? What if you gave the medication and the child went to PE or playground and hurt themself? I'd go to Student Services and let them know your concerns before I accepted anything, even with a doctor's order. ... I can't imagine they'd approve.

Interesting question, though. I hope you get an answer!

mc3:nurse:

Jolie, BSN · Nov 3, 2011

First off, I would refuse to accept the medication without an accompanying order. If Mom did not yet have a physician's order, I would have sent the med home with her. I'm not a storage clerk.

Second, any prn order must have clearly stated parameters that can be quantified, understood and followed by anyone who might be required to evaluate the student and administer the medication. That must be clearly indicated in the doctor's order. "Give Xanax 1 tablet to Johnny for anxiety as needed." won't cut it.

Third, our medication form requires the prescriber to list side effects to be watched for and parameters for calling the parent/physician.

I have accepted orders for anxiety medication for kiddos in my schools, but none were prn, as that involves a much higher level of involvement on the part of the physician (which they don't want to be bothered with), in order to safely and consistently administer and monitor the medication.

Lastly, this a med that we count. It must be hand delivered by the parent and signed in by the parent and a med-certified staff member. Each dose is counted, and if any is to be sent home, the parents must come in and sign for it.

Flare, ASN, BSN · Nov 4, 2011

update: The doctor faxed me an order for 0.125 mg at 11 am if needed for anxiety. I had faxed a note to state that I would like to be called, but that didn't happen. Spoke to the school psych about this - she does not necessarily feel that this student is having anxiety that needs to be controlled with Xanax - rather that this student is more so trying to avoid work. Our plan is to phone the doctor together to speak to him about this order. The other concern is that the kid took one 0.25 mg dose in the am and was completely snowed by it and had to be picked up by 10:45.

Ahh - this situation is giving me agita... now I need a xanax :hdvwl:

Jolie, BSN · Nov 4, 2011

I would suggest having the physician list specifically what observable s/s constitute "anxiety" in this student.

Handwringing? Hyperventilation? Sobbing? Getting up from his desk and wandering the room?

How are staff members to know when to administer this med?

Flare, ASN, BSN · Nov 4, 2011

i spoke to the parent again, who was pretty insistent that since i had an order that i am obligated to give the med. I then placed a call to our school physician who didn't necessarily express my concerns of a 13 y.o. taking this particular drug at school, but rather the vague parameters to give it. I also placed a call to the ordering doc and left a message to set up a call between the doctor, the school psych and me. at this point i have not given the med - and my intention is that should i be forced to, it will certainly not be given if the student seems drowsy to begin with. The fact is that this student usually appears drowsy.

Am I making a big stink out of nothing? Should I just go along with this order, withholding for drowsiness??

mycsm · Nov 4, 2011

I would first get a complete written order from mdwith guidelines. Fax what you need signed to the doctors office. Write out specifically and have if check it off ,sign it STAMP IT and send it back.

second: double count meds with parent standing next to me and have parent sign next to total EVERYTIME they bring in new meds.

Jolie, BSN · Nov 4, 2011

You are not obligated to give anything that hasn't been sufficiently clarified by the ordering physician in order to be given safely.

If the parent wants it given in the meantime, s/he can come administer it.

I can't help but wonder if this is a situation where a parent has nagged a physician into ordering a med that the physician may or may not believe is truly necessary. In my experience, physicians readily respond to phone calls regarding medicines they strongly believe are necessary to a child's well-being.

Has the child been taught any other coping skills or relaxation methods. Perhaps a multi-pronged approach would be beneficial and help to limit the need for medication. Is this something the psychologist would work on?

mc3, ASN, RN · Nov 4, 2011

I would suggest having the physician list specifically what observable s/s constitute "anxiety" in this student.
Handwringing? Hyperventilation? Sobbing? Getting up from his desk and wandering the room?
How are staff members to know when to administer this med?

Right, that's my concern also!

mc3:)

morte, LPN, LVN · Nov 4, 2011

sounds like the makings of a homemade drug addict......

Flare, ASN, BSN · Nov 5, 2011

Jolie, i've voiced the same concerns and have a feeling the parent did just that. I mean the kid didn't have the order for 24 hrs when the parent showed up in my office to get this given in school. This means they didn't try it first to see if it was even necessary to get a school order. Mom just came in spouting off that because it wasn't an order for xanax xr that she felt it would be necessary for this child to have a second dose while in school.

My plan until i can speak with the preseriber is to tell mom she is free to come in and medicate her child if needed.

@ morte -that's my concern as well - i even mentioned to mom that xanax is highly addicting and she just spouted off that her child is very anti drug.

I suppose we'll see what Monday brings

morte, LPN, LVN · Nov 5, 2011

I am anti government intervention, for the most part. But this mom would be on my last nerve, finger on the phone for DYS.