Something for all you school nurses...

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First off, I am not a nurse. I am a caregiver for a diabetic relative who has mobility issues due to a stroke. I am also a teacher assistant for a first grade class in a school that has a large population of health-challenged students (mentally and physically).

There is a student in my classroom who has been just diagnosed with asthma. Her mother brought an asthma inhaler to the school nurse without the proper letter from the physician/documentation. The school nurse where I work (an RN) accepted the asthma inhaler from the mother because, as the nurse said, she would rather we have the inhaler there and explain it later than for it not to be there and the child have an attack and need it. The nurse one day called me to the door of my room and told me the child would be carrying it in her backpack (backpacks are kept in lockers during school hours). She said she had discussed it with the child's mother, and they had agreed to keep it in the child's backpack, but not let the child know that it was in there because she would be tempted to take it out and play with it (that was the red flag right there that she wasn't responsible enough to have it in her backpack). The nurse told me that if she needed the inhaler, to let the office know. The child has never been observed having any asthma symptoms at school.

It sounded like a bad idea to me, but I have only been in education for about 7 months (most of that time as a substitute teacher). However this RN is the one that approves how meds are handled in the school, so I didn't argue with her.

Well, the crap hits the fan yesterday! I find out the child is carrying the inhaler around in her pocket. I take it from her and remind her that she is not supposed to have it. Too late! While on the playground during an activity that where neither the teacher nor I was present, this child has let about 8 children take puff from the inhaler!! All of those parents had to be called, and there are parents that are still upset today.

I am not a nurse, and I am not trying to act like I am, but I think it was a bad idea to accept the inhaler from the parent without the proper documentation in the first place. If this had of been a different kind of medication, then this could have been much more serious. I mean, I am sorry if a child does not get the meds they need because their parents do not bring the proper documentation, but that is the parent(s) fault and not the school's. The other kids have to be protected too. If it is a medication a child really needs, and the parent goes through the right process to have it at the school, I can't see a school not working with that parent.

Just thought you all might find this helpful or interesting.

Specializes in School Nursing.

This is why I do not accept inhalers without the properly signed permits. I might get some flack for that, but I am not going to risk my job and potentially my license if the unthinkable happens and I have to decide whether or not to give a med that I do not have an order or parent's permission to give. Yes, if a student needs their inhaler, they need it. However, it is a parental responsibility to provide the correct paperwork for any med to be in school, and I will not take this responsibility upon myself.

I generally advise the parent to take the child with them to the MD office to get the paper signed, or I will offer to fax it to them and call the office to speed the process along, but they must wait in my office until the paperwork is done before I will accept it. I will absolutely not take the inhaler and tell them to bring me the permit when they can, and there is no way in hades I would let the child carry it, whether or not the child knew about it! That was extremely poor judgment.

Specializes in School Nursing.

I am a school nurse. In our district, in order for a student to carry an inhaler, the doctor has to sign he gives permission to carry the inhaler, and in addition, he must sign he taught the student how and when to use it! The parent and the student then must sign also. I would NEVER accept ANY kind of medication for a student at school without the PROPER documentation. In not doing so, I don't always make friends. Oh well, not only are the students protected, but so am I, and so is my school district. I am appreciative of the parents who will have the student carry an inhaler AND keep one in my office also.

Not only could you lose your license, but if what if another child takes the medication that some student brought (like in this case) and the child gets sick, has an allergic reaction, dies, etc.? That would be horrible, and that could have happened at my school yesterday!

I am a school nurse. In our district, in order for a student to carry an inhaler, the doctor has to sign he gives permission to carry the inhaler, and in addition, he must sign he taught the student how and when to use it! The parent and the student then must sign also. I would NEVER accept ANY kind of medication for a student at school without the PROPER documentation. In not doing so, I don't always make friends. Oh well, not only are the students protected, but so am I, and so is my school district. I am appreciative of the parents who will have the student carry an inhaler AND keep one in my office also.

I have never had to do this for any of my children. Is it so hard to get proper documentation. Couldn't that be done in the doctor's office when the doctor is prescribing the medication?

Specializes in Nephrology, Cardiology, ER, ICU.

Merged both threads.

Specializes in Maternal - Child Health.
Keeping it in the office would not be acceptable. If a child has an asthma attack they need it right away.Time spent going to get it, unlock a door or a drawer could be the difference between life or death. A young man died in my area because he had left his in his locker.By the time someone managed to get it he was gone.

But I do agree that he proper documentation should be followed.

I understand that you intend to advocate for the student by insisting that the inhaler be kept on her person.

But an inhaler is not only useless, it is potentially very dangerous, in the hands of a child too young and immature to understand its use and safe handling, as is obviously the case with this first grader.

I can assure you that a typical first grader would be incapable of promptly identifying and responding independently to the early s/s of an asthma attack. This is a level of skill and awareness that is not usually reached until about the age of 10 - 12.

Younger children are far better served by having medications in the safekeeping of a responsible adult (nurse, teacher, health assistant, etc.) who is well trained in identifying the need for, and proper use of, an inhaler, Epi-pen, or other emergency medications.

This is also important for the safety and well-being of classmates and the protection of the school district from liability.

Question: can't you get the proper documentation at the time the medication is prescribed (I don't know, never had to do this for any of my children)?

I took stacks of Medical Authorization forms to all the local physician's offices so they could WRITE IT AS THEY PRESCRIBED THE MEDICATION!!

Sheesh . . . .seems so simple to me.

However, I still have to follow-up on many of the meds by calling parents. Seems like the physician's offices would like to streamline this.

I have a new Kindergarten student who will be starting next Fall - at Kindergarten registration his mom wrote he was allergic to bee stings. When I called her to ask for more details, she said they gave him Benadryl. I told her I needed a physician's order for even Benadryl and she should ask about an epi-pen as well. He's been bit 3 times and each time was worse . . .

Follow the rules or it will bite you in the tush. ;)

Specializes in kids.

frustrating scenario....i work with hs kids and i am sure there are those who are carrying an inhaler that have no paperwork.(despite letters home, in the newspaper, in the handbook etc that every parent signs...)

if i am given an mdi (or knowledge of the student having one), the first thing i do is get parent permission form signed and fax it to the pcp....and part of that form is the pcp signing off along with the parent, the child is able to carry and self administer.

however, as noted in other threads, the school nurses are sometimes the last to know of a situation.....

.when i do have the mdi i make sure it is labeled (both canister and plastic holder) with name.

in an ideal world a little light bulb:idea: would go off when the pcp determines the need for meds at school

the pcp writes an order

the parent asks for a copy of the prescription order

the child is instructed on proper use and demonstrates that knowlwedge

both parent and pcp sign the form acknowledging such

the parent delivers the medication to school as written in the handbook

parent signs the school form

the parent stays long enough to fill out and discuss the asthma action plan so that it can be sent to the pcp for review and signature

the child then goes off the class with the process all done appropriatley and they are ready to help themselves in the event of an asthma attack

sadly,we do not live in an ideal world......:nurse:

I understand that you intend to advocate for the student by insisting that the inhaler be kept on her person.

But an inhaler is not only useless, it is potentially very dangerous, in the hands of a child too young and immature to understand its use and safe handling, as is obviously the case with this first grader.

I can assure you that a typical first grader would be incapable of promptly identifying and responding independently to the early s/s of an asthma attack. This is a level of skill and awareness that is not usually reached until about the age of 10 - 12.

Younger children are far better served by having medications in the safekeeping of a responsible adult (nurse, teacher, health assistant, etc.) who is well trained in identifying the need for, and proper use of, an inhaler, Epi-pen, or other emergency medications.

This is also important for the safety and well-being of classmates and the protection of the school district from liability.

Couldn't have said it better myself.

Oh my, what a mess. Our policy is very clear on this, thankfully. If the inhaler comes with the box that has the Rx label on it, that label is considered an MD order and a parent can bring it in as long they sign consent for us to give. The box and inhaler are kept in the clinic. If the doctor (not the mother) indicates on a written form - either RX or on the medication consent form that child has been trained and is fully capable of managing their inhaler, they are allowed to keep it. If not, it must be kept in the nurses office. No question. If this child has an asthma attack, I can be called to wherever they are and be there in under a minute to administer med. That is what I'm there for. If any questions, 911 is called. No exceptions. Do you know what that medication could have done to one of the other kids? We had a situation like that (not our school) a long time ago, and the child's parents and school were sued. It was not pretty.

No way, no how would I have allowed that. I think the RN was being irresponsible and not looking at the bigger picture.

Just my 2 cents worth....

mc3 :nurse:

Oh my, what a mess. Our policy is very clear on this, thankfully. If the inhaler comes with the box that has the Rx label on it, that label is considered an MD order and a parent can bring it in as long they sign consent for us to give. The box and inhaler are kept in the clinic. If the doctor (not the mother) indicates on a written form - either RX or on the medication consent form that child has been trained and is fully capable of managing their inhaler, they are allowed to keep it. If not, it must be kept in the nurses office. No question. If this child has an asthma attack, I can be called to wherever they are and be there in under a minute to administer med. That is what I'm there for. If any questions, 911 is called. No exceptions. Do you know what that medication could have done to one of the other kids? We had a situation like that (not our school) a long time ago, and the child's parents and school were sued. It was not pretty.

No way, no how would I have allowed that. I think the RN was being irresponsible and not looking at the bigger picture.

Just my 2 cents worth....

mc3 :nurse:

Our RN here is not full-time at this school. She shares her time at other schools. I don't know who would give the medication if she is not here and a student needs it. I am sure there is a plan, it is just that I don't know it.

I would not have taken the inhaler without documentation from the doctor. If the asthma is that bad to need it at school right away, sorry but you need to keep the child home and bring me back the appropriate paper work.

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