MEDICATIONS IN SCHOOLS: SECTION VI

Janie Lee Hall, School Health AdvocateOffice of School & Adolescent HealthNMDOH, Public Health Regions 1&3Presented by: Lee Carn, RN,BSN, RRPS

Definition:

A medication is any substance that is ingested,

injected, inhaled, or used topically in the diagnosis,

treatment and/or the prevention of disease.

This includes prescription drugs, over-the-counter and non-prescription drugs, and non FDA-approved herbal/homeopathic remedies.

Options for Medication Administration in School

1.PED licensed professional school nurse (RN)

2.Delegation to appropriate staff (LPN/CMA/UAP/HA)

3.Student Self-Administration (strict criteria)

Self-Administration:Students may be allowed to assume responsibility for carrying and administering their own 1-day supply of medications (excluding controlled substances) provided that:

• Self-administration is approved in writing by the prescribing health care provider, and the parent/guardian;

• Nurse evaluates the student’s ability to safely & accurately self-administer.

Guidelines for Medications in Schools1. Whenever possible, medication should be given at home.

2. Parents must provide the school with written medication orders each school year and each time the order changes

• Orders must be signed by the PCP and the parent/guardian.• The licensed professional school nurse must transcribe the orders

onto the appropriate school forms prior to the medication being given.

3. Parent/guardian is responsible for providing the school with a pharmacy-labeled container and all medication

4. Un-used medication should be disposed of or returned according to written school board policy.

Medication Containers

The Label must have the following:• Name of the student• Name of the medication• Drug strength and prescribed dosage• Route of administration• Time scheduled for administration• Name of prescribing health care provider (PCP)

The 6 Rights:

Right student

Right medication

Right dosage

Right time

Right route

Right documentation

And, the right reason,

That makes 7

Safety, Safety, Safety!!

The Six R’s should be triple checked each

and every time medication is administered.

First, when taking medication out of storage area.

Second, when assisting student with his/her medication.

Third, when returning medication to the storage area and documenting.

Teach the students to answer these 5 questions:

Name (student’s)• What is your name?

Medication• What is the name of your

medication or is this your medication?

Dose• How much do you take?

Ordered time to take• When do you take this?

Purpose of medication• Why do you take this?

Administering Medication to a Student:

• Wash hands between each student• Identify each individual student• Unlock medication cabinet • Take the medication container out of the cabinet• Compare the label name and the student name with

the MAR before administering the medication• Administer medication with out touching• Document (6th right)

Precautions: Only a licensed professional school nurse can

transcribe the original order onto the MAR Only a nurse can take verbal orders or changes

in the medication order from the provider. Medication errors or omissions must be

reported to the nurse and documented.

MEDICATION ERROR & INCIDENCE REPORT

Errors may include the following:• Wrong student • Wrong medication and/or dose • Wrong route • Wrong time• Missed dose

Over-the Counter Medications:• OTCs are often requested by the parent;• Decision to administer requires school nurse’s

judgment -- so only a nurse (or the parent) can make the decision to give OTCs;

• Each district should have a policy for OTC meds.• Comfort measures should always be utilized first.

Same Day Field Trips

Optimally, a separate “single dose” field trip supply of medications (in an originally-labeled pharmacy container) should be made available by the PCP and parent/guardian

Alternately, the originally-labeled school supply should be checked out to the adult who is trained and delegated by the school nurse to administer the medication

State Laws:

Each local education agency must adopt a written policy that meets its students’ needs for prescription and non-prescription drugs.

All schools are required to authorize students to carry and self-administer asthma treatment medications, anaphylaxis emergency treatment medications, and diabetes treatment medications (under specific conditions).

Emergency Medications:

Albuterol, Epinephrine, Glucagon & Oxygen The School Nurse is responsible for training

adult employees to administer these emergency medications when they are ordered at school.

Medication Storage:

Routine medications should be stored in a lockedcabinet in a secure area;

FDA guidelines and national standards require thatall controlled substances be stored in a doublelocked narcotic cabinet that is equipped with twoseparate locks and keys.

Refrigerated Meds:o Antibiotic elixirs usually require refrigeration.

o The refrigerator should be in a secure area and not be accessible to unauthorized individuals.

o Food should not be kept in the same refrigerator as medications.

o The temperature should be checked daily when school is in session and should be maintained between 36 and 46 degrees Fahrenheit.

TRANSPORTING MEDICATION:

Each school district should develop a written School Board policy addressing the issue of transporting medications. Topics to cover in this policy might include the following.

• Medications transported to school• Medications transported from school• Medication transportation for emergency evacuation

during the school day

Disposing of Medications

Parents should be notified that it is their

responsibility to pick up any unused medications• Never give students unused medications;

even if parent instructs you to do so

PED licensed RN should dispose of unused medications with adult witness

To Ensure Maximum protection:

• Use approved prescription and over the counter authorization forms for parents and providers with signatures yearly and as needed.

• The PED licensed school nurse must review, transcribe and sign all medication authorization forms.

• Parent/guardian is responsible for providing the school with the medication in a pharmacy labeled container or the original manufacturer’s container.

Remember:

1. Always exercise great care with medications to ensure the safest possible care for students.

2. Keep students and yourself safe by meticulously following state guidelines and school district medication policy.

3. When in doubt, ALWAYS ask the school nurse!

NOTE:

Poison Control (800-222-1222) is a valuable resource when you have questions about a medication.

QUESTIONS?