New medication policy in effect in Rock Hill, Clover schools

rsouthmayd@heraldonline.comAugust 17, 2013 

A major medication policy change will start affecting all parents and students in Rock Hill and Clover schools this year. School nurse Joy Bower at Dutchman Creek Middle School in Rock Hill checks equipment in the health room.


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    There is one major exemption from the medication policy: EpiPens.

    The handheld injection device delivers a dose of epinephrine, or adrenaline, most commonly to stop allergic reactions, which can cause life-threatening symptoms.

    The new policy does not extend to EpiPens, said Keith Wilks, executive director of student services for Rock Hill schools, because a state law enacted in June exempted them.

    “We have always know that it’s a bit of problem,” said Dr. Martha Edwards, a Rock Hill pediatrician.

    The devices can cost $200, she said, and parents are simply non-compliant and don’t make their children carry one even if there are known allergies. There are also kids who have unknown allergies, she said.

    “There are reported cases across the country where the kid died because there was no EpiPen available,” Edwards said.

    Now, schools will have EpiPens on hand and nurses will be able to administer them without parental or physician consent in the same way they would be allowed to use an automated external defibrillator if a student had a sudden cardiac problem.

    “It really is a life-saving measure,” Edwards said.

    Rachel Southmayd

School nurses in Rock Hill and Clover schools are no longer allowed to dispense medication of any kind without the written permission of a doctor – a major policy change as classes resume this week.

“Water and air,” said Keith Wilks, the executive director of student services in the Rock Hill school district. “That’s all they can give.”

He said the changes will be frustrating for everyone.

“Parents are having to get a prescription for everything,” he said.

The hope is to soon allow physicians to give standing orders for individual children, giving blanket permission for certain medications or treatments, but Wilks said that’s not permitted yet.

So what exactly will happen when a student needs that Tylenol or Benadryl – or even something as simple as Orajel – and no doctor’s order has been given?

“Call home,” Wilks said. “That’s all we can do.”

Joy Bower, the school nurse at Rock Hill’s Dutchman Creek Middle School, said if parents can’t be reached, students will just have to sit in discomfort if there’s no doctor’s order for medication.

That could mean more missed instructional time, she said.

One local pediatrician has already seen an increase in the number of orders she has had to write before the beginning of this school year.

Dr. Martha Edwards, with Rock Hill Pediatric Associates, said many doctors are already worried about the increased demand in their offices.

“We’re already annoyed,” she said. “That’s putting it mildly.”

In recent years, Edwards said, her office had already seen an increase in schools requesting that physicians write prescriptions for over-the-counter treatments in school, but now that it’s required, it creates a lot more work for staff.

At Rock Hill Pediatrics, she said, if a child has had a physical in the last year, a visit won’t be required to write an order for an over-the-counter medication, but there might be a charge for processing. A spokesperson for the Carolinas HealthCare System, which includes Rock Hill Pediatrics, said this is not the case and there will be no cost for prescriptions for over-the-counter medications unless there is an office visit required, which would incur the standard charges.

Fort Mill schools adopted the new policy last spring, and York schools have had a long-standing policy that states any student not in high school needs a doctor’s order to receive over the counter medications.

Robin Brown, Fort Mill’s district school nurse in Fort Mill, said the transition wasn’t difficult.

“It went over very smoothly,” she said.

By allowing nurses to give students medications at their discretion, Brown said, nurses had to diagnose conditions, which they shouldn’t do in a school environment.

That practice also taught students that there was a pill for every problem, she said.

The only medications of any kind you’ll find in the health room in a Fort Mill school are Vaseline, hydrocortisone cream, antiseptic wipes and saline eye wash.

Local doctors have been helpful with the policy change, Brown said. Many have been willing to fax orders to a school if the child needs something during the day.

Even dentists and orthodontists, she said, have written orders for Orajel or ibuprofen for students with painful orthodontics.

The change has reduced the amount of traffic in the health room by 10 to 15 percent, Brown said.

Bower, at Rock Hill’s Dutchman Creek, said school nurses today have far more students with chronic conditions requiring monitoring.

So, while she might dislike the hassles the new medication policy presents, she thinks reducing health room traffic could be helpful.

“There’s a lot going on,” she said.

The key for families preparing to adjust to the new policy is to be proactive, Brown said.

“They just need to talk to their family physician about what issues the child might have,” she said. “You don’t want to wait until they need it.”

State mandate?

While the Rock Hill school district has advertised the policy change as a reflection of state law or an interpretation of state law, state regulators say they haven’t issued any such edicts.there has been no official or definitive changes made.

The state Department of Labor, Licensing and Regulation oversees the state Board of Nursing, which regulates school nurses. Agency spokeswoman Lesia Kudelka said LLR has not instructed school districts to change their policies.

The state Department of Health and Environmental Control used to recommend that school districts create their own policies regarding the distribution of medicine in school, DHEC spokesman Jim Beasley said.

But DHEC and LLR have since determined that only the boards regulating medicine, nursing and pharmacy have the authority to create those policies.

Cathy Young-Jones, DHEC's school nurse consultant, asked for clarification on school medication policies from the Board of Nursing, which referred the matter to a task force.

That group will meet Aug. 30 to address these questions.

“Common sense tells us parents shouldn’t have to jump through hoops for their children to get basic medication,” Beasley said.

One exception

Rachel Southmayd •  803-329-4072

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