Unusual med order?

[J-lynn]

I am working at a high school & don't give the meds. It is a very large campus with two buildings & I just can't be in two places at once.

So today, I was about to go into a 504 identification meeting when the secretary--who was leaving for lunch--told me one of the students hadn't come down for his medication. I told her we needed to get him down & went into the meeting. He didn't come in until twenty minutes later. I had told her we had an hour either way.

But when he came in, I looked at the orders. He had Ritalin 10 mg TID. I'm assuming dad gives the morning dose. According to the orders, we give 10 mg @ 11:45 & 2:15. We were basically an hour late, so I phoned dad to let him know we wouldn't be giving the afternoon dose. I just didn't feel comfortable with it.

I am new at school nursing....Is this a normal dose to be giving so close together? Wednesdays will be even harder. We would have to give it at 11:25 & 1:43 or else pull him out of class. I was planning to call the parent about it because I don't have a release to call the NP.

Thoughts?

[grammy1]

Doesn't your medication consent form contain a release to speak with the provider regarding medication questions? Our Emergency Medical Cards and Medication administration forms both give us consent to speak with the physician regarding any medical issues or conditions that we may encounter at school.

[J-lynn]

I am sure it does....I will give her a call and make sure it's ok to give so close together. Thanks!!

[Amethya]

10 mg, seems small dose for Ritalin. Maybe they want to space it out by an hour to make sure he doesn't get too much of the medication at once? I had to do this myself for my medication, because 20 mg would cause me horrible anxiety but if I space it out, I felt fine.

[ruby_jane, BSN, RN]

Tardy to this party but...that's odd. Perhaps the student tried a longer-acting med and it did not work. Perhaps the provider is not schooled in best practice (three hard dumps of Ritalin seems brutal but....hey, if it works)...

What happened when you called the provider?

[rbytsdy]

You can call to clarify the orders. I would not hesitate to call for something like that. I had a student in a similar situation. The doses were ordered 2 hours apart. I called and the NP was surprised that she had the timing so close together.

[J-lynn]

Thanks Ruby Jane & rbytsdy. I haven't done anything about it. I've been so incredibly stressed. Not sure school nursing is for me. I worked as a school nurse at a very tiny school but now I have a very large high school & an elementary school & I am struggling. My bp today was 150/108 & my normal is about 100/70! Thanks for the input. It has truly just not been on my radar since I first noticed it. I've had so many challenging situations. But the paperwork is what is killing me. & I have no office so I am lugging everything around everywhere!

[KatiejonD, RN]

Hmm. I wouldn't feel comfortable giving it. What I would do is call the parent and specifically request they sign a release so that you may collaborate with the student's PCP. I know that in my state, I was able to give certain information TO the PCP even without a release - I just wouldn't be able to hear back from them.

Much like at a hospital, where if an order doesn't look right, we have the responsibility to get clarification - I would insist on this order being clarified and/or corrected by the PCP in writing, before I would give the medication.