DD not given medication due to 'paper work'

[DraggleTailedWench]

Still fuming hours later so I need to get this off my chest.

My 11 mo has eczema, has been prescribed cream for a time to be used throughout the day. The box has contrary instruction so the nursery have said they need to have word from the doctor to give it to her. It doesn't say the instructions in full on the printed sticker from the chemist for some reason. I think its fair enough as they aren't medical professionals at nursery.

The problem is the doctor. Firstly the receptionist refused to let me speak to the doc who prescribed the medication as they aren't my daughter's registered doctor. Then the registered doc calls me up and says he refuses to email or phone or write a note for the nursery as it is a waste of NHS time and money!

Thankfully I can still administer the cream at home and the effect over a day wont be detrimental. BUT this is prescribed medication that I'm being prevented from giving DD, firstly by procedures in nursery (that are fair enough) and then by doctor! Ridiculous.

[ClutchingPearls]

What cream is it?

DD2 has sever eczema and has never has a problem with nursery putting them on. They even do her demasilks for me when her eczema is really bad.

[DraggleTailedWench]

hydrocortizone

[lurkerspeaks]

The person preventing your daughter getting her medication is not the doctor. He has prescribed it and explained it to you (her primary carer).

You are choosing to delegate it to nursery who are refusing to accept your explanation.

I would imagine that if you want the doctor to communicate with nursery they will but only if you pay for the time it takes to draft a letter. Writing letter for nurseries is not NHS work.

On this occasion YABU.

[hedwig2001]

Take it back to the pharmacy and get them to label it correctly.

[monkeysbignuts]

its not the gp's fault. they normally charge for writing letters emails etc.
Hydrocortisone is a difficult one because its very very strong. Can you ask the chemist to print out more clear instructions?
Is it temporary? When I used it for my dd they said no more than 7 days

[catkind]

Go back to the nursery, explain that doctors can't do this, maybe offer to write and sign a letter yourself explaining exactly what needs doing. It's not like they can't see the medicine is prescribed for your daughter. I do think they're being a little over-cautious here.
Or could you ask for a repeat prescription, and photocopy it before it's made up - would the prescription have the full instructions on?

[McHappyPants2012]

i would write a letter myself giving the nursery instructions.

if they failed to give the cream after that i would be moving her to a nursery who can put abit of cream on a child.

[ClutchingPearls]

1% yep they have done that countless times and she's now on alot higher and they still do that.

Our nursery have never needed the doctors input.

I can see the doctors POV that its routinely used without too much worry and most people wouldn't think twice about using it. Its even available at the supermarket.

I would ask the nursery why they have concerns and what guidelines they are following then seek advice from whoever it is.

Also if it doesn't resolve you could ask your GP for hydrocortisone ointment that tends to hang around on the skin longer.

[catkind]

(And hydrocortisone isn't strong, unless it's an unusual %. It's about the weakest eczema cream you can get, it's available over the counter. Not that any steroid treatment is to be taken lightly for babies. )

[DraggleTailedWench]

That may be the best way, hedwig2001.

What would you have me do lurkerspeaks?

It looks like I'm just going to have to sort it out on our follow up appointment TBH.

It makes me mad when rules stop people following their common sense. I have considered going down the the nursery myself at lunch time to apply it.

[catkind]

x-post...

[Sirzy]

In what way are the instructions contrary? It does sound like the nursery are being over the top - if you give written signed instructions then why can't they follow them?

DS has an inhaler at nursery which is labelled "give 2-4 puffs as required" however after his recent attack they were more than happy to give 5 puffs because I had signed the medicine form to say that was what was needed.

[monkeysbignuts]

it is strong. I was told with my daughter to use it for no more than 7 days & avoid undamaged skin as it can burn it.
I have used it myself and know how strong it is. Steroid cream thins the skin out.

[DraggleTailedWench]

Hmm, ok, so overall opinion seems to be to lay off the doctor and speak more strongly to nursery. I'll speak to my friend who works in another nursery too and see if their policies would be as strict. She hasn't been there long so I'm not used to them yet.

[Sirzy]

The nursery should have a medication policy in place ask to see that and see what it says

[BartletForTeamGB]

Yes, the doctor has given the instructions which are now printed on the box. This is the nursery's problem.

Ofsted says:

Deciding whether to give medication
You will need to decide what medication, if any, you will give and to make sure that parents understand your policy on giving medication. The Early Years Foundation Stage does not specifically say you have to give medicine to children.
If you do not want to give medication, you will need to consider what other measures you would need to take when children are in pain, have a long-term medical condition or otherwise need medication. You will need to show that these other measures do not discriminate and they promote the good health of children. You must also make sure you make your policies clear to parents.
When deciding what to include in your policy, you should make sure that you meet any legal requirement and consider if your policy promotes the good health of all the children you care for. You should also consider if your policy reflects procedures for:
 who will give any medication
 how you store medication
 recording how you give medication, and
 training staff if there is a specific medical need.
It should include the steps you will take if a child becomes ill or has a long-term medical condition.
If a parent or carer wants you to give their child medicine, you must get the parent?s or carer?s written permission and instructions showing the dose, how often it is given and so on. If these instructions are from a doctor and exceed the dose recommended on the packaging you may want the parent to confirm in writing their agreement to you dong this.
This applies to each and every medicine a parent wants you to give.
It does not apply to every time you give the medication. For example, you will need permission at the start of a course of antibiotics, but not for every time you give each dose of the antibiotic during the course of the treatment. You should keep this information in a safe place.

[goldenlula]

The pharmacy can only put the instructions that the doctor puts on the prescription, so if the doctor has written 'as directed' on the prescription this is what they will put on the label. I would do as others have said and take it up with the nursery. Our school will give paracetamol liquid if we fill a firm in so I can't see why they will not apply cream if you provide written consent ad instructions on use.

[DraggleTailedWench]

Thanks all. I remain a little bitter over my conversation with GP, but will get over it and tackle nursery instead. [looks satisfied but still mildly put out that initial rage wasn't shared]

Thanks for the extract as well Bartlet, since it is Ofsted that nursery are concerned about at the end of the day. Poor DD. Hate leaving her. But that's another story!

[TinyDancingHoofer]

Hydrocortisone is not strong, you don't even need a prescription, obviously would use it without one for a 11mo though. Arf at burning skin, unless i have somehow become immune.
OP, just give them the cream without the box and tell them to follow your instructions.

[porcamiseria]

fake the letter

go to their website, get their logo and fake it

sorry, but needs must!!!!

[BartletForTeamGB]

"fake the letter

go to their website, get their logo and fake it

sorry, but needs must!!!!"

That's a crime. Do that to me and I would report you to the police.

[TinyDancingHoofer]

wouldn't use it without one! Bloody phone.

[BionicEmu]

If it helps, my nursery have never been bothered by instructions from a doctor. DS is on several medications, and I just have to tell them what dosage and when and sign his medicine sheet. Some days he needs 3 meds, other days just 1. They've also been v supportive when we've been trialling dosages and timings. As long as I tell them and sign, they're happy.

So it seems to me that it's the nursery that are being a bit awkward!

[BartletForTeamGB]

draggle, I have the PDF but can't find it on the Ofsted site, so PM me with your email address if you'd like me to forward it to you.

tiny, hydrocortisone is strong for children. Officially you need a prescription from a doctor to use it for children although now DS needs it relatively regularly and I don't want to waste an appointment each time I run out of a tube, I just get it from the pharmacy and hope they don't ask who it is for.

[lurkerspeaks]

If you cannot sort this out with nursery (and it really is a problem between you and them) reapproach the GP and ask them to write a letter acknowledging that you will have to pay.

Lots and lots of organisations default to "GP letter" when it isn't necessary and if GPs routinely performed all of these tasks they would have no time to do the work that they are actually paid to do by the NHS -see, treat and manage sick patients.

Communicating treatment discussions between the primary carer and a delegated secondary carer does not fall into this remit.

DO NOT fake the letter. As others have said this is illegal. If you GP discovers at best you will be asked to register elsewhere. At worst you might find yourself the subject of a police investigation.