Standing Medication Orders???

[TNUp2Jen]

I will be a new camp nurse this summer, working as the only medical professional at a Girl Scout camp for 90+ campers. I'm wondering how this works: I've seen a few posts here and there regarding standing medication orders - meds parents agree can be given to their child to treat common minor problems - tylenol for fevers, benadryl for bee stings, motrin for menstrual cramps - etc. I'm wondering - where do we (as nurses) draw the line for administering meds?

If anyone has any experience in this, please help by answering any of these questions:

1. What meds are on "standing orders" at your camp?
   
2. Do you have a "blanket" permission slip for parents to sign agreeing to all meds, or do they "check" the specific meds they will allow for their children?
   
3. What do you do if a parent does not agree to sign the standing order form and their child is in the nurse's office with severe pain b/c of something treatable like a headache or menstrual cramps???

As I said, I'm new at this - it seems almost silly that parents would allow their kids to sit inside an infirmary all day because they don't want them to have 325mg of Tylenol. Simple fix! Any ideas on implemenation?

THANKS!

Jen

[BonnieSc]

Some parents just really don't like medication, especially for non-urgent situations... I think others just want to avoid medication errors and so they say no medication at all.

I don't have a copy of our orders here, but off the top of my head: tylenol, ibuprofen, benadryl, oil of cloves, kaopectate, pseudoephedrine, tums.

Our permission slip is a blanket one, with space for parents to write any specifics. Lots of parents write "no aspirin" (duh!) and some write "no ibuprofen". Sometimes parents have sent Chinese or homeopathic medications with their kids; I've never had to administer them, though.

If the parent says "no meds" or the kid refuses? I do whatever non-medical things I can (and I do those for everyone, whether they're also getting medication or not)--water and shade for headaches, hot water bottles and exercise for cramps. If the kid is really suffering, I'll call the parents and make sure I'm doing what they'd want me to do. Sometimes they'll say "OK, go ahead and give some Tylenol".

The most important thing I do when giving treatment is ask: "What do you do when this happens at home?" You can get a lot of information from that question.

Sometimes I feel like what I do is damage control: I try to figure out exactly what the parents would want, because they'll be unhappy if, according to them, you've undertreated OR overtreated. Make sure you check the health form / med permission for EVERY kid, EVERY time.

And where do we draw the lines for administering meds?... exactly where the standing orders / protocols do. I very seldom have anything that's not covered by them. We've sometimes had nurses who were uncomfortable with giving meds, feeling that they're diagnosing. OTCs treat symptoms, and giving them doesn't imply diagnosis, unless one ignores signs of something more serious.

[TNUp2Jen]

Wendy:

Wow, GREAT advice...I'm thinking of printing this tread just to make sure I'm up to speed when I get to camp!

I like your question "What do you do when this happens at home". So simple, yet gets right to the heart of the matter.

I'm glad you also included your note that giving OTCs isn't diagnosing...I've been wondering about that myself. Good to point out that they treat symptoms.

Thanks for this!!!

[edgwow]

Dear Jen

The standing orders are still signed by a physician, the camp physician or a physician in the community that you send the injured capers to.

Out permission slip is as follows, this is for both day and residential camp.

There are specific instances when the healthcare officer on duty feels that your child would benefit from a dose of over the counter medications. All attempts will be made to contact the parent prior to the administration of any medication. The following medications may be administered per label directionsfor age and weight.

Tylonol for headache or Temp> 100.5

Ibuprofen cramps

Benadryl -allergic reaction

tums- upset stomach

Pepto-bismal- greater than 4 loose stools in 24 hours

The parent signs this in the packet along with consent for the camp to seek emergency medical care in the event of a potentially life threatening injury.

Parents that do not sign it get a phone call from me to make sure they understand the implications of not signing it. Child will recieve no meds from the nurse and may need to go to the hospital for care ie: multiple bee stings.

I believe that you would still need written permission from the parent, just like in school for OTC's.

[edgwow]

Wendy, speaking of every /kid/ every time reminds me

Make sure if some one has an allergy to erythromycin you call and find out how severe it is

You won't be giving that but the polysporin or neomycin base antibiotic cream/ ointment used on cuts is the same type of base

[kcangel, LPN]

Wendy's reply said almost everything I would say and do as well. Our registration form (right in front of me, I'm getting ready to sign my son up) has a yes or no box that they check off in regards to giving "over the counter medication, non-prescription medications or applications, not to exceed the recommended dosage for stomach discomfort, burns, cuts, insect bites, rash, aches, fever, cough, congestion, etc" and "list exceptions...". Then there is a separate area for prescriptions.

There have been times I've had campers in who did not have theirs signed and I've just called their parents to ask them if it was an oversight or if they had any concerns. Almost always works out that is was an oversight.

Drawing the line - not exceeding dosages or time, protocols; also realizing there is another issue that needs to be addressed (homesickness, dehyrdation causing the headache, etc.)

[campmonkey]

Would anyone mind sharing their camp standing orders? The camp where I work as never had any and I would love to show an example to our visiting doctor to discuss setting up our own this summer.

We have a consent form that all parents are required to sign and return to us before the beginning of camp and only administer the medications listed both don't have any specific guidelines to follow.

Thanks!