trips

Alex Egan, LPN, EMT-B · Jan 25, 2014

Our trip meds are given by the OPT department, they do all our off camp trips. They receive special training to give meds. We pack them in excruciatingly detailed packs. Broken down per kid, per med pass , each with the drug, dose, name, and time. Those are matched against a master list. We send a nurse along on two of our massive half camp trips to the amusement park with the young kids. The older kids do not get a nurse because there are not as many meds. In this case the head staff give the meds from the excruciatingly detailed packs. We have an astonishing number of off camp trips and trip packing is about 33% of the job. One of the major challenges is the growth hormone injections. The camper must be able to self administer the injections if they take the med off camp, but the storage of the drug is a challenge. This doesn't include sports trips. These are done between meals so generally only PRN and emergency meds are sent. If a noon med is to go the nurse educates the trip specialist on when and what to give. If the sports trips run into questions we tell them to call us or speak to the other camps nurse.

Erikadawn RN · Jan 26, 2014

We pack our meds in labeled envelopes with instructions for them to be given. Usually the senior staff gives them, only our teens go away for extended days. The younger kids on overnights we administer before they leave and after they return in the a.m.

CampNurse1 · Feb 19, 2014

Check your state's Nurse Practice Act on repackaging. Surprisingly, Alabama has a part of its Nurse Practice Act that addresses camp nursing. In our case, it specifically prohibits repackaging of any kind. We have to administer directly from a pharmacy container. Blister packs or roll (pillow) packs are best. Other states have rules for nursing homes and the like, but not for camping. Other states do not mention repackaging at all.

Some camps use Camp Rx or some other pharmacy to take care of this issue, which is probably best.

I am uncomfortable preparing any medication for a lay person to give. I would rather stay out of it. I understand that if a camp has been doing this for many years, it is tough for the nurse to rock the boat. This is a good conversation to have during the hiring process. It is a big gray area.

I never did like the idea of lay people giving meds at camp. A one or two day course in medication administration in no way provides the training needed to safely give meds. They may learn the 7 "rights," but can never learn pharmacology, adverse reactions, non-administration principles, etc. We nurses know it takes a big skill set to safely administer medications.

I do understand if only nurses were allowed to give meds most group homes and half the camps would have to close.

I am not pretending to know what the rights and wrongs of this issue are. I am just saying be careful, and practice in a manner you can defend. Repackaging for lay people to administer is tempting. It is convenient, and should work about 999 times out of 1000. If anything goes wrong, it could get ugly in a hurry. Temporary or contract employees, such as nurses, will go under the bus before full time employees do.

Of course, nurses make medication errors all the time. I did a metastudy on error rates when I first took this job because we are special needs here and 85% of our campers are on meds, many of them polypharmacy cases. Depending on the study one looks at, the error rate is anywhere from 2% to 22%! These errors were made by trained professionals, not lay people. You get the point. I remember the jaws dropping in the meeting room when I presented this data. This is one of the advantages of being a year round nurse. I have time during the winter to do wacky things like data gathering.

No system is perfect. I had a sharp nurse find an error in a blister pack last summer. She noticed the number of pills in the pack did not jibe with the number on the MAR. Be careful, and fall back on your training. Nursing school was torture for a reason.

I guess I'd better write an article on medication principles and practices at camp. Darn! Another chore!

Alex Egan, LPN, EMT-B · Feb 19, 2014

I think it's very important to consider the setting of your camp when considering setting policy. I agree, and advise, using a pharmacy that packages the meds. It just makes sense. I wish our camp director took people who duck the camp meds system to task more, because it's those 10% that cause 50% of the work for us packing a trip.

Most of our kids are on well established medication routines, and in my population poly pharmacy is only a concern for 4 of our 500+ kids. So I'm not so concerned with adverse reactions. If little Tommy has taken these same meds for a year It would be unusual to have him start not tolerating them now.

Med trained staff should only be giving routine meds and not making clinical judgements. It's a very important role of the camp nurse to balance safety and procedural matters with the goals and needs of camp. It's quite a tightrope to walk. Our camp has been working very hard over the last few years to tighten up the trip packing as part of our continuing quality improvement. I think it's something that everyone should be constantly trying to improve.

A special needs camp is a whole other ball of wax. So many meds! I worked at a camp for children on ventilators and I thank God we worked on the medical model first and the camp model second. Also glad we didn't do any trips at that camp.

CampNurse1 · Feb 19, 2014

As always, Big Al, you add much to the conversation. You are one of the gurus here.

Alex Egan, LPN, EMT-B · Feb 23, 2014

Oh geeze I don't want to be a guru. I'm just trying to add perspective. Campnurse1 how do you pack? Do you send MARs? also does your camp send nurses on trips, due to the medical needs of your campers?

Alex Egan, LPN, EMT-B · Mar 21, 2014

Well I spoke to soon. My boss and I just finished reworking the trip packing system. Mini MARs will go out for each kid. On each trip. That progress.