standing orders

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Do you have standing orders at your school/district? If so, what are they for? We have been discussing this for common items such as hydrocortisone, Tums, ibuprofen, etc. but I'd love to get some feedback from others first.

Specializes in IMC, school nursing.
We are a private school. Each student has a health info card where a parent checks off in August "yes" or "no" to the following meds:

Acetaminophen

Antihistamines

Ibuprofen

Decongestants

Topical Ointment/Lotion

Tums/Mylanta

This allows me to be pretty free and allows me to choose the dose in regards to weight and severity of symptoms. I always notify parents when I medicate a student and let them know the dosage amount and how I came to that amount. OR if a parent has marked NO on a med that I think the student could really use, I will call home and request it and 99% of the time the parent will ask for me to give it at that point.

May want to check with your nursing board. May be more appropriate to send out prescription sheets with specific orders - Tylenol dose weight/age appropriate prn for fever > 100.4F or pain for the child's physician to sign. Parental consent is not adequate in my state.

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Just for non patient specific epinephrine. Everything else needs parent permission and Drs orders.

Same for our local school district. Our state has passed laws for stock PR Diazepam for seizures but we don't have any orders for that as we have NO volunteers to do it. No way is a teacher gonna get near a PR med. :no:

I wish we had a medical director.

Our district is too small and we don't have a physician/medical director. It took us forever to find a physician for our entire county to write an Rx for epi.

We have to have individual parental consent/physician orders for any kind of med at school. We don't have stock inhalers, cough drops, or Vaseline.

:wacky:

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Specializes in IMC, school nursing.

We are private and I had no school nurse before me, and I was new at it. (I still ask myself how I got myself into this) Looking at the practice act for my state I realized that I could not use parental consent to medicate with prn's, even though the volunteer secretary could. I called a neighboring county's school nurse (our county does not use protocols) and asked if it would be possible to get a copy of what they use. I have a few doctor parents who are willing to help anyway possible. The director of the school nurses called me and said I could use their protocols if I had a physician to sign off on them. Free, fast and friendly. I got a willing parent MD to sign off and become our "medical director".

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Specializes in ED, School Nurse.

We have standing orders signed by our school physician (I've never met him!).

Per standing order, I can give Tylenol and ibuprofen with parental permission.

Without parental permission, student can get icy hot, Tums, Benadryl for allergic reactions (not seasonal allergies), Epi-pen, hydrocortizone, bacitracin, orajel, cough drops, lubricating eye drops, albuterol inhaler (we have a stock albuterol MDI). I can also use vaseline, Eucerin cream, and aloe vera gel. Oh yeah- and Carmex (this is very specific and it makes me laugh) for chapped lips.

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Specializes in School nurse.

We have a school physician (required by law) who is a local pediatrician. They are required to provide physicals if there is no medical home and approve home instruction as well. Standing orders are annual and include epi, glucagon, and nebs (by law) and also 02. Additionally, there are orders for typical OTC meds like Tylenol etc with a dosage range and reason for use etc. Lastly, there are standing orders and protocols for A to Z ailments. So for Asthma the kids needs a medical dx and asthma action plan (by law) which outlines care. Burns, bleeding, cramps and so on are outlined as first aid protocol. You get the idea. It's pretty comprehensive.

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Specializes in School Nursing, Hospice,Med-Surg.
We are private and I had no school nurse before me, and I was new at it. (I still ask myself how I got myself into this) Looking at the practice act for my state I realized that I could not use parental consent to medicate with prn's, even though the volunteer secretary could. I called a neighboring county's school nurse (our county does not use protocols) and asked if it would be possible to get a copy of what they use. I have a few doctor parents who are willing to help anyway possible. The director of the school nurses called me and said I could use their protocols if I had a physician to sign off on them. Free, fast and friendly. I got a willing parent MD to sign off and become our "medical director".

Thank you for this info!

My clinic has been set up for several years to my coming on so I've made the assumption that all was being done correctly. I'm definitely going to look at my state practice act now and double check on all I'm doing. Outside of my OTC meds I have specific written and signed orders for all meds.

Thanks again!

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Specializes in IMC, school nursing.
Thank you for this info!

My clinic has been set up for several years to my coming on so I've made the assumption that all was being done correctly. I'm definitely going to look at my state practice act now and double check on all I'm doing. Outside of my OTC meds I have specific written and signed orders for all meds.

Thanks again!

You're welcome. That's what I love about this site. Breaks the isolation and we have a blast. I was surprised when I found out OTC needed orders, but then I rationalized that I can't just grab a Tylenol or milk of mag for my patient in the hospital. Luckily I had a coworker who subbed for the county give me a heads up as to what they had in place.

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Specializes in School Nursing, Hospice,Med-Surg.
You're welcome. That's what I love about this site. Breaks the isolation and we have a blast. I was surprised when I found out OTC needed orders, but then I rationalized that I can't just grab a Tylenol or milk of mag for my patient in the hospital. Luckily I had a coworker who subbed for the county give me a heads up as to what they had in place.

That makes perfect sense. I thought the same thing when I worked it through my brain!

I read through all 31 pages of my state's practice act and couldn't find a single thing on this. Then I found requirements for all the surrounding public schools in my state and they were varied but quite lax. My local public schools allow MS and HS kids to self carry and self-administer most OTC meds. So I've found that I'm actually quite a bit tighter than our public schools which was a bit shocking to me.

I still feel a wee bit uncomfortable with what I'm taking on after talking to you guys and may still begin to ask for standing orders on all my meds. I have a doctor mom who already acts as my pseudo medical director in that she writes my epipen scripts whenever I need them for the school. I'll have to chat her up and see what her opinion is on this.

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The only thing I can give my students is Bactine spray and Halls fruit breezers because there is no medication in it. I do use saline drops in their eyes. I am no allowed to use anything that has medication in it. I wish I could give more.

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We have standing orders for topical meds-Bactine, Vaseline, etc. as well as Tums and cough drops. Som of our neighboring districts have orders for Tylenol or ibuprofen, but we have avoided that and make the parent get an order from their own doctor. I have been questioning if we need parental consent to use these things. I know we do, but am not sure how to go about getting permission. I hate to tell a kid they can't have contact solution just because we don't have permission.

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Specializes in IMC, school nursing.
That makes perfect sense. I thought the same thing when I worked it through my brain!

I read through all 31 pages of my state's practice act and couldn't find a single thing on this. Then I found requirements for all the surrounding public schools in my state and they were varied but quite lax. My local public schools allow MS and HS kids to self carry and self-administer most OTC meds. So I've found that I'm actually quite a bit tighter than our public schools which was a bit shocking to me.

I still feel a wee bit uncomfortable with what I'm taking on after talking to you guys and may still begin to ask for standing orders on all my meds. I have a doctor mom who already acts as my pseudo medical director in that she writes my epipen scripts whenever I need them for the school. I'll have to chat her up and see what her opinion is on this.

The easiest work around would be the pre printed scrips, have check boxes/ blanks for your prn's and have the pediatricians sign them. If you really want to have fun you could call your board for clarity. Good luck.

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