My SW texted me today around 4:30, after work, and said that one of the 10th grade girls, who was staying after school for theater practice, had anxiety and could he give her an Ativan.
She gets Ativan 0.5mg prn anxiety. She started the year with 10 pills, she has about 4 left. She took one yesterday, and I know she has increased anxiety about the play.
I do not doubt for one second that she wanted/needed the Ativan.
I do trust the SW.
I told him no. I would not let him administer her the meds, nor would I tell him where the keys to the cabinet were. I told him to call her mom, or that I would, and have her come get or medicate her daughter. He did not press, then later texted me and said she got through it.
However, I just read through my state laws again and saw no exclusion for PRN medications administered by unlicensed personnel. Not every school has a nurse present all the time. With proper training and documentation, unlicensed personnel can administer PRN medication. This has to be the case in some schools. Otherwise students who need PRN meds, say for anxiety, have to wait until a nurse is present before they can be medicated? That's not always plausible, nor beneficial for the student. How does this work, for those school nurses who cover more than one school, or who are part-time?
The law in my states actually includes provisions for "Special Activities" which I imagine after school activities would fall under.
I still think Farawyn was right not to allow the SW to administer the medication. My wheels are spinnin' with all these different scenarios, though. :)
While I agree that nursing judgement was best for this situation, I am not sure that Ohio Law would agree. Most of the time in the school PRN does not = nursing judgement. The most common PRN medications in my school are emergency asthma inhalers, Epi-Pens and Benadryl. At the beginning of every school year, I conduct staff medication administration training primarily for these medications and Ohio Law allows trained staff to administer them. There are no special provisions for anxiety medications or the like. Nothing in the Law prohibits them from being administered by trained unlicensed staff. That being said if a student in my school needed prn anxiety meds, I would want to talk to the prescribing physician to perhaps establish some ground rules and make sure that he/she is aware that an unlicensed staff member may be giving the medication in the event that I am not available. In fact I would want it documented on the Medication Permit under special instructions.
In my state (Maine), there is an entirely separate provision for emergency meds, like rescue inhalers/epi-pens/glucagon. I train staff each year on the administration of these medications as well.
And we do administer anxiety meds to students at my school. I can think of 4 students off the top of my head who get anxiety meds from me on a semi-regular basis (one of them being my own daughter). I work only with high school students.
What is a medication permit? Would that be like what I call a medication administration consent form?
If unlicensed staff are able to give medications, I would hope there are explicit instructions and guidelines to help staff identify if the PRN anxiety medication is needed. There should be some training in advance.
I think you did the right thing in this case. It sounds like things turned out ok. It can be used as a "teaching moment" and a means to open a dialogue about this topic since there doesn't seem to be a protocol in place.
I would have had the student call her parent and have them bring med to medicate her.
No way would I have taken on that liability that the SW can give a med. You think the SW would take FULL responsibility if something happened.No..it would have fallen back on you.
SnugglePuggle, MSN, RN
170 Posts
While I agree that nursing judgement was best for this situation, I am not sure that Ohio Law would agree. Most of the time in the school PRN does not = nursing judgement. The most common PRN medications in my school are emergency asthma inhalers, Epi-Pens and Benadryl. At the beginning of every school year, I conduct staff medication administration training primarily for these medications and Ohio Law allows trained staff to administer them. There are no special provisions for anxiety medications or the like. Nothing in the Law prohibits them from being administered by trained unlicensed staff. That being said if a student in my school needed prn anxiety meds, I would want to talk to the prescribing physician to perhaps establish some ground rules and make sure that he/she is aware that an unlicensed staff member may be giving the medication in the event that I am not available. In fact I would want it documented on the Medication Permit under special instructions.