HOME › Forums › Camp Health › Brand new to day camp nursing + disorganized health center
Tagged: day camp, standing orders; healthcare plan
- This topic has 5 replies, 5 voices, and was last updated 3 years, 8 months ago by
Tracey Gaslin.
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May 18, 2021 at 2:58 pm #42573
Tara Holahan
ParticipantI’m excited to start as a camp nurse at a local day camp. The director and I have been deep into the Covid details, but now I’m finding gaps in the his knowledge about how the nurse/health center function regularly. I have lots of questions, and have been deep into my education.
#1: Is it mandatory that we have an overseeing physician for camp with standing orders for OTC and emergency meds? The director thinks that parental permission on the heath screening form is enough, and we don’t need epi in the first aid kit.
#2. Can you tell me what the minimum standards for a day camp center are and where I find examples? I think I will need to hunt for past examples of Health Center documentation/policies, and I want to be able to ID the gaps and improve existing.
thank you, Tara
May 18, 2021 at 5:43 pm #42575Mary Marugg
MemberHi Tara, These are great questions!
#1 In most states, if a parent sends an OTC with their child you can give it as the parent instructs. But for any OTC and emergency medications that the camp stocks you must have a prescriber (MD or nurse practitioner) sign a set of standing orders. Check your state guidance. I see your address is Pennsylvania, if the camp is in Pennsylvania there are guidelines for day camps. See the “State Specific” page on the ACN website: https://www.allianceforcamphealth.org/education-and-resources/state-specific-resources/
#1(b) Regarding Epi in first aid kids, you will need to check your state regulations to determine who can give emergency epi if you are carrying it in first aid kits. If an auto-inject is prescribed for an individual, they can administer it to themselves, but as a health care professional you would need a standing order to administer it. Here is a link to a recent ACN document on epinephrine, to include state regulations on “unassigned” epi. https://www.allianceforcamphealth.org/2021/05/07/epinephrine-at-camp-2021/
#2 Check this link for state regulations: https://www.allianceforcamphealth.org/education-and-resources/state-specific-resources/ I see your address is in Pennsylvania. If your camp is also in Pennsylvania you’ll find links specific regulations for day camps.
You’ll find some good basic information on health services for day camps in the 2020 version of the Camp Nursing: Basics and Beyond textbook by Erceg and Gaslin. https://www.allianceforcamphealth.org/product/basics-of-camp-nursing/
Your questions are good, and it sounds like the camp is lucky to have you seeking good answers.
Mary
May 18, 2021 at 7:46 pm #42582Lynne Rodrigues
ParticipantHello Tara!
My name is Lynne Rodrigues. I am a Pennsylvania school and camp nurse. If your camp is indeed located in the state of Pennsylvania, our state has strict guidelines for the administration of medications. Indeed, Pennsylvania is one of the more restrictive states in the country. As a nurse, you must have signed orders from a doctor in order to administer ANY medication including over-the-counter medications. You must even have a separate order directly from a physician for prescription medications. You cannot use the bottle alone as an order. Medications must always come in their original, labeled bottles or packages. Tablet and capsules in a baggie are not acceptable. You could get around this standing order issue if every parent submitted a physician’s health form with whatever medications the doctor agrees to have administered for the patient listed and signed off on. This would mean you would need to double check every campers orders to be sure the doctor ordered them to have medication X. As a nurse, we cannot take directives from solely from parents for the administration of medications. Clearly, we do still need parental consent to administer medications. In the state of PA, nurses must have both parental consent and a doctor’s order.
As for an epinephrine autoinjectors, I believe they are important to have on hand for the unknown anaphylactic reaction. That being said, if your director is unwilling to include them in the plans for camp you may not have a choice. Hopefully, camp has quick, easy access to 911 for any possible anaphylactic emergency. Maybe your camp director could discuss some of these concerns with their insurer. The camp insurance policies may have direction for these situations.
Please feel free to reach out to me with any additional questions. I will do my best to help.
Sincerely,
Lynne RodriguesMay 25, 2021 at 8:05 pm #42640Matthew Hecht
ParticipantLynne is right on with everything she wrote about PA. It is a v. restrictive state.
To highlight:
– absolutely need standing orders for medications, this needs to be signed yearly.
– the camp should notify guardians of the OTC meds available (from the standing orders) AND give them the chance to opt out of the medications. (FYI: we do not allow parents to opt out of benadryl or epi- we require their permission for attendance)
– the health center should have procedures and protocols. (see the ACN website for good examples)
– procedures should include things like: the refrigerator temp should be checked and recorded daily, the AED is stocked and pads up to date, etc.
– protocols should be what to do in common health situations at the camp. They can be specific to the camp. (ie. in an emergency, the nurse will go to the patient, the director will stay by the phone)
– both the procedures and protocols should be written as if you weren’t at camp to explain them. A nurse new to the camp should be able to understand what is expected of them without much more context.
-One of the things that can be lacking in a ‘rustic’ health center is the mode of documentation. It’s still a requirement to document what is given and done as well as who is notified and when. Make sure you have a system for both, and please know that the health log (many camps keep a health log that describes what each person came to the health center for) is not enough. A unique record should be made for each unique camper. If you are on a computerized system this should be no big deal and you are probably doing it anyway, if its paper, create a document that works, it does not have to be an all-encompassing document, (I fit two to a page and it meets my needs.)Hope this helps.
-Matt
June 15, 2021 at 2:20 pm #42777Tara Holahan
ParticipantHi there! Thank you for the advice, and for the 1:1 call. you helped me clear my head and be ready for my next discussion with the camp director. I was able to avoid stalemates that started with him saying that I was the only one who had questions, wasn’t comfortable giving out OTC without standing order and was looking for policies.
Plan:
We have no med director so only daily/prn meds for individuals with PMD note/order and parent permission will be given. I have been contacting parents who’s children have daily meds, asthma and known ANA allergies and they will send the PMD plan used at school with all labeled meds.If a child comes in non-emergency and may benefit from an OTC I will call parent to discuss, possibley contact PMD if needed.
Unsolved problem:
I am looking now for a way to keep ben/EPI on site and admin for the ‘surprise’ allergy. The camp is a suburban location and close to 2 hospitals, director says that EMS arrival has been less that 5 min in the past.
Is this enough?
TaraJune 15, 2021 at 11:19 pm #42783Tracey Gaslin
MemberTara:
Thanks for sharing your challenges. We all learn through our shared experiences. I want you to know that if a camp director is trying to “call you out” for asking questions, seeking guidance, or wanting policies, this may not be a good camp for you (or others). A good camp director is eager to partner with the healthcare staff and find the support and documentation needed to create a successful and safe camp experience. Never be afraid to ask questions or seek clarification. You are ultimately responsible for the care of individuals on the camp and you need to feel ready for the task.
I would still encourage you to look for a prescriber to provide oversight at camp. It is hugely helpful to have someone to review medical protocols, standing orders, and treatment options. It can be physician, but could also be a nurse practitioner. Look at your state regulations.
Every camp should have benadryl and epinephrine onsite. These are basic emergency safety measures. Finding a way to do this is important. If your state allows for stock epinephrine, then a prescriber can write for an epinephrine autoinjector for you to have available for emergencies. Keep investigating, learning and growing. You will appreciate the effort later.
Best to you
Tracey Gaslin -
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