Medication Training

/Medication Training
Medication Training2017-01-14T12:17:04+00:00
VII. MEDICATION AT SCHOOL

The district is authorized by RCW 28A.210.260-270 and RCW 18.71.030(3) to administer prescribed oral medications to students during school hours or while students are in the custody of the district. The district will authorize its employees to administer prescribed oral medications to students only when the student requires such medication in order to attend school, school sponsored activities, or when the student is susceptible to a predetermined life endangering situation.

A. Definitions

  1. Prescribed oral medication: all prescribed or over the counter oral medication dispensed to student on a scheduled or as needed basis upon written authorization from a parent and accompanied by written instructions from a licensed health care provider.
  2. Licensed professional: a registered professional school nurse licensed pursuant to chapter 18.88 RCW and employed by the district.
  3. Designated personnel: those district employees described in Section B below.
  4. Parent: parent, legal guardian, or person having legal control over the student.
  5. Current: each school year.
  6. Licensed health care provider: any person listed in RCW 188.79.040 with prescriptive authority (eg. physician, dentist, osteopaths, PA, ARNP, naturopaths, and chiropractors).

B. Designated Personnel

  1. The principal, secretary and clerk are to be trained annually in the administering of oral medication .
  2. The building principal may request that additional staff members be authorized to administer prescribed oral medication
    1. The request should be submitted in writing, along with the reason for the request, to the school nurse.
    2. The person must be trained prior to administering oral medications.
  3. In addition to those staff members authorized to administer oral medications, the building principal may request specific staff members to be authorized to administer medications in specific situations (i.e. field trips, some classrooms for the disabled, emergency medications). a. The request should be submitted in writing to the school nurse and should include the names and positions of the staff members the principal would like to designate along with the reason for the request. b. Staff designated to administer medications in a specific situation may only administer such medication within the specific situation.
  4. Only employees of the district may be designated to dispense medications.

C. Training and Supervision

  1. The district’s school nurse shall, under the general direction of the director of special services, train and supervise designated personnel in the proper administration of prescribed oral medication.
  2. Only designated personnel who have received such training and licensed professionals shall administer prescribed medication.
  3. The district’s school nurse shall also, under the general direction of the director of special services, provide training and supervision to those staff authorized to administer prescribed oral medication in specific situations.
  4. All training shall occur as requested by the building principal and approved by the director of special services.
  5. The district’s school nurses shall supervise designated personnel by conducting periodic reviews of medication administration procedures.

D. Procedures

  1. Designated personnel shall administer prescribed medications to students only when the district has received (see Attachments 15 and 16, Authorization for Administration of Oral Medication at School):
    1. Parent/legal guardian request and instructions
      1. Such request must be made in writing. The request must be current and unexpired.
      2. The request must be signed by a parent/legal guardian.
    2. Health care provider requests and instructions
      1. The request must be made in writing and signed by the student’s health care provider. The request must be current and unexpired.
      2. The request must state that a valid health reason exists which makes administration of the prescribed oral medication advisable during school hours or during such time that the student is under the supervision of school officials.
      3. Written, clear, legible, current, and unexpired instructions must be obtained from the student’s current health care provider regarding the administration of prescribed oral medications for students.
      4. These instructions must be nondiscretionary.
      5. Both the request for administration or medication as well as the written instructions from the health care provider must be received by the school prior to the delivery of medication.
    3. Medication
      1. The medication must be furnished in an original container from the pharmacy with the student’s name, the name of the medication, dosage and the amount to be given.
      2. All medications should be in a form ready to be administered and should not require any preparation by the designated personnel.
      3. It is the parent/guardian(s) responsibility to deliver and maintain an adequate supply of medication at school. The medication may not be delivered by the child or school bus driver.
      4. The principal’s designee will attempt to notify the parent when the medication supply is low or completely out.
      5. If there is a need to change the student’s dosage and/or time of administration, the health care provider must submit a new written request. If there is a dosage change, a newly labeled original container from the pharmacy shall be provided to the school.
    4. Inhalers
      1. In most cases, inhaled medications will be administered in the school office or health room under oral medication procedures.
      2. In the event that the health care provider and parent indicate that a student in grades four through twelve (4-12) must carry their metered dose inhaler on their person, the authorization form must be on file in the office.The student must demonstrate to the professional registered nurse at the school the skill level necessary to use the medication and any device that is necessary to administer the medication as prescribed.
      3. The staff will not be held responsible to record daily dosages.
    5. Self Medication
      1. In the event a health care provider and parent/guardian request that a student be allowed to self medicate at school, the health care provider and/or parent/guardian shall complete an Authorization for Self Administration of Oral Medication at School Form.
      2. The original of this form, signed by the health care provider and/or parent/guardian, will be on file in the school prior to the student initiating self medication.
      3. All students who are authorized to medicate themselves at school shall carry only one day’s dosage of the medication.
      4. A copy of the completed Authorization for Self Administration of Medication at School form, signed by the health care provider (prescription and/or over-the-counter medications) and/or parent/guardian must be on file in the school’s office.
      5. The following age appropriate guidelines should be followed taking into account the developmental level of the students:
        • scheduled prescription drugs (Ritalin, methylphenidate): grades 9-12;
        • metered dose inhalers (provental, albuterol): grades 4-12;
        • oral medication (Tylenol, aspirin, Motrin): 7-12 grades;
        • non-oral medications (insulin, eye drops, ear drops, topical ointment):
        • grades 7-12.
  2. The district will assume no responsibility or liability for the administration of the medication should a student medicate himself/herself at school or at school sponsored activities.
  3. If a student is noncompliant with self medication procedures, the principal will follow the procedure for unauthorized drugs on school grounds or use professional judgment to determine action to be taken (see Administrative Procedures No. 3200 P-1).

E. Procedures for Administration of Prescribed Oral Medication

In addition to compliance with all other requirements set forth in this procedure, the principal/designee shall:

  1. Administer prescribed oral medication in substantial compliance with the written instructions of the student’s health care provider. This shall include, but not be limited to, the administration of medication not earlier than one half hour before and not later than one half hour after the time designed by the health care provider.
  2. Examine the prescribed oral medication before administration to determine if it appears to be in the original container and is properly labeled.
  3. Keep an accurate record of all prescribed oral medication using district recording forms (see Attachment 18, Written Record For Dispensing Oral Medication).
  4. Follow hygienic practices when administering any medication (e.g., direct handling of oral medication should be avoided).
  5. Destroy all medication left at the end of the school year which has not been picked up by the parent.
    1. The school nurse shall provide general direction to the designated personnel on the most appropriate way to destroy the medications. In every case, the oral medication shall be:
      1. Destroyed by one of the individuals authorized to administer oral medications;
      2. Witnessed by another member of the building staff;
      3. Documented using an appropriate district form which shall be maintained in the school office; and
      4. Medication records shall be kept for eight (8) years following the last dose.

F. Medication Error

  1. In the event a medication error should occur (e.g., an incorrect dosage, time, or incorrect medication), the staff member who administered the medications shall immediately call the school nurse assigned to the building and notify the building principal. They shall follow the Guidelines for Handling Medication Errors (see Attachment 19) and the appropriate action shall be taken.
  2. The employee responsible for the incident shall complete a Medication Incident Report form (see Attachment 20), documenting the error that occurred, the action taken by the school personnel, the persons contacted as well as recommendations to prevent such an error from occurring in the future. A copy of the report shall be sent to the director of special services, the building’s school nurse, and the original will be kept in the building where the incident occurred.
  3. In every instance of medication error, the student’s parents and the building administrator shall be notified.

G. Safekeeping of Prescribed Oral Medication

Designated personnel shall assure safekeeping of prescribed oral medication by:

  1. Keeping all medication in the original container;
  2. Storing the medication in an appropriately sized, secured and locked cabinet located in the school office area or when necessary within a locked container within a school refrigerator; and
  3. Keeping no more than a one month supply of such medication at school at one time.
  4. Only designated personnel shall have access to a school’s medicine storage cabinets.

H. Student Participation

  1. It is expected that students will cooperate with the district’s designated personnel in administering prescribed oral medications.
  2. Any student who repeatedly fails to cooperate will be subject to discontinuation of medication at school.
  3. Keeping no more than a one month supply of such medication at school at one time.
  4. Only designated personnel shall have access to a school’s medicine storage cabinet.

I. Discontinuance of Medication

  1. All health care provider authorizations will automatically expire at the end of the school year and are subject to renewal in the succeeding year.
  2. The district is not required by RCW 23A.210.260 to administer oral medication to students. If for any reason the building principal, school nurse, or staff with the responsibility for the administration of medications believe that the school should discontinue administration of medication to a student, they shall:
    1. Convene a committee consisting of the building principal, parent/guardian, school nurse, and staff member with the responsibility for administration of medications;
    2. Present the reasons for their concern and what action(s) they have taken in response to the concern; and
    3. Decide what action, if any, will be taken.
  3. If it is the committee’s decision that the district should exercise its discretion and discontinue the administration of medication, the committee shall:
    1. Document their decision using a district Discontinuance of Medication Form.
    2. Forward a copy of the Discontinuance of Medication Form to the director of special services.
  4. The committee’s decision may be appealed by the parent to the director of special services.

J. Field Trips

While students are in the custody of the school district, but away from the school building, medication will be administered according to the medication policy and procedure with the following modifications.

  1. Designated personnel will be trained by the school nurse to administer the medication.
  2. Medication if needed must be kept on the person designated (e.g., fanny/back pack) or with a designated adult.
  3. A copy of the health care professional’s directions must be with the medication.
  4. Medication is in a labeled container. The container must be clearly marked with: Childs name; medication name; amount to be given; time to be given.
  5. Medication must be examined before leaving school grounds to assure proper dosage is given.
  6. Designated personnel will be responsible to see that the container returns to school.
  7. The designated personnel who administers that medication shall be responsible for documenting administration on the permanent medication record at school.

K. Epinephrine/Anaphylaxis

  1. No medications shall be administered by injection by school personnel except under extreme conditions.
  2. If a student has a known allergy to bee stings/food and may need an emergency injection, the following procedures will be followed:
    1. Parents and health care providers will complete an Individual Health/Auto Injectors Plan Allergy/Anaphylaxis Secondary to Bee Stings or Individual Health Plan Allergy/Anaphylaxis Secondary to Food Allergy (see Attachments 22 and 23).
    2. The parent/guardian will be notified if epinephrine dosage is administered and 911 will be called.
    3. The principal is responsible to see that the epinephrine accompanies the student if the student leaves school for a school activity.
    4. Epinephrine must be in auto injection form.
    5. Only staff trained by the school nurse may administer EpiPen® to a student in an emergency. (see Attachment 24)
    6. The principal/designee will notify the school nurse if a student registered in the building has a known life threatening allergic condition and has an epinephrine dose at school.
  3. Upon request, the building principal will provide a copy of this procedure to the parents for administration of medication in the schools.
Do…

  • Determine if the medication is properly labeled and in the original container
  • Check the expiration
  • Make sure the medication label matches the healthcare provider’s written instructions

Don’t…

  • Accept medication that is past expiration date
  • Accept medication that does not match the healthcare provider’s written instructions
  • Accept medication that is not in the original container
  • 1970 Comprehensive Drug Abuse Prevention and Control Act established rules for narcotics, depressants, stimulants, and hallucinogens
  • Nurses may administer controlled substances only under the direction of a licensed physician
  • Controlled substances must be securely locked and only authorized personnel should have access to those substances
  • There are criminal penalties for the misuse of controlled substances
GUIDELINES FOR HANDLING MEDICATION ERRORS AT SCHOOL In most circumstances, medications are to be administered no sooner/later than thirty minutes from prescribed times. In rare circumstances, should a dose be missed, follow the guidelines below. Asthma-inhalers: give as soon as possible after missed dose, notify parent by phone send note home with student if parent is not reached by the end of the school day. Ritalin: give as soon as possible after missed dose, notify parent by phone. if second dose is scheduled during the school day, delay second dose so that there is a least three to four hours between doses. Send note home with student if parent is not reached by the end of the school day. Antibiotic: give as soon as possible after missed dose, notify parent by phone. Send note home with student if parent is not reached by the end of the school day. Other medications: call parent, give as directed by parent. if parent cannot be reached for directions, send note home with student notifying parent of missed dose. In all cases an Incident Report should be filled out and sent to the school nurse. Let’s work together to reduce missed and late doses, and keep administration of medication safe and responsible.
Right Person

~Be sure you have the right person before administering medication

~Ask the student to state their full name

Right Medication

~Check the bottle’s label against the physician’s authorization

~Be sure they match

Right Dose

~Double check the amount of medication before administering

~Be sure the amount to be given is clearly understood

Right Time

~Medication is to be given in substantial compliance with the physician’s request

~ Within one half hour before or after the scheduled time

Right Route

~Designated school staff are authorized to administer oral medication only

~Do not administer ear, eye, nose drops, topical medication, or injected medication

  • Non-licensed school staff administer medication under the license of the school nurse
  • Before giving medication at school, non-licensed designated staff must be trained by the school nurse
  • Training should be updated annually
  • This tutorial is designed to provide training and updates for designated school staff
  • The school nurse is responsible to supervise the administration of medication in the school setting
~Contaminated hands are a prime cause of cross infections

~Hand washing is the most important and most basic technique in preventing and controlling the transmission of germs

Do…

~ Wash hands before preparing medications as recommended by The Centers for Disease Control (CDC)

~Discard medication that has been accidentally dropped

~Use the bottle cap or a paper cup to shake out pills and return excess to bottle

Don’t…

~Administer medication that has been contaminated

~Handle medication with your hands

Nurses

  • Nursing Practice Acts-defines the scope of nursing practice
  • Registered nurses are licensed by the Board of Nursing of the state in which they practice
  • Licenser permits persons to offer their special skills and knowledge to the public
  • Licenser provides legal guidelines for the protection of the public
  • A nurse’s license can be suspended or revoked by the Board of Nursing if he/she violates provisions in the statute
  • A nurse who gives care that does not meet appropriate standards may be held liable for negligence

Designated Staff

  • The staff member designated by the school district to administer medication does so under the license of the school nurse
  • A staff member who administers medication without training and supervision by the school nurse could be criminally liable for practicing medicine without a license
  • At the end of the school year notify parents/guardians if there is excess medication
  • If they do not pick the medication up before the office closes for the summer dispose of it safely
  • Dispose of medication as directed by local health department. If occasional drugs are flushed dispose with another staff member present.
  • Auto injectors should be sealed in a container, such as a pop bottle and placed into a trash bin that is not accessible to children
Medication is to be administered by designated building office staff.
Do…

  • Be sure when faxing an authorization form to get the parent signature on the back of the form
  • Call or page the school nurse if directions are unclear
  • Call or page the school nurse if a telephone request is needed
  • Call or page the school nurse if there are problems or concerns regarding the administration of medications
  • Remind parents/guardians that they may administer the medication to the student themselves if all the requirements are not met

Don’t…

  • Give a student medication without written authorization from the healthcare provider
  • Give a student medication without written authorization from the parent/guardian
  • Give a medication if the request from the healthcare provider or parent/guardian is unclear
  • Take a medication request by telephone, only the school nurse may offer that service
Trade name  Generic name  Used for  Standard dose
 Adderall, Addrell XR  Dextroamphetamine salts  ADHD 5-30 mg
Advair Fluticasone Asthma 100-500 mcg per puff
Advil, Motrin Ibuprofen pain relief / anti inflammatory 200- 600 mg every 4-6 hrs
Albuterol,  Proventil, Xopenex Albuterol Salts Asthma 1-2 puffs q. 4-6 hours
Aleve Naproxen pain relief / anti inflammatory 250 mg, 2-3 times perday
Augmentin / Amoxi Amoxicillan antibiotic 20-500 mg. per day
Beclofen none muscle relaxant 10-20 mg
Benadryl Diphenhydramine Anti histamine 25 mg. – 50 mg.
Claritin Loratadine allergy 10-20 mg
Clonidine Catapres ADHD 1 mg.
Dexadrine Dextroamphetamine ADD/ADHD 5-20 mg.
Dramamine Dimenhydrinate anti-emetic 1-2 tablets
Epi-Pen Epinephrine Hydrochloride allergy/anaphylaxis Jr. or Standard
Focalin Dexmethylphenidate ADHD 5-20 mg.
Hydrocodone bitartrate/acetominophen pain 2.4/500 – 10/750 mg
Imitrex Sumatriptan Migrain 25 mg.
Insulin Humalin, Novalin Lantus Diabetes see orders
Lamictal Lamotrigine anti-seizure 2-200 mg
Luvox Fluvoxamin anxiety 25-100 mg
Penicillin Penicillin antibiotic 250-500 mg
Pentasa mesalamine ulcerative colitis 250 mg
Risperdal Risperadone Anti-psychotic .25-4 mg
Ritalen, (Concerta) Methylphenidate ADD/ADHD 5-30 mg (18-54 mg)
Strattera Atomexetine ADHD 10-60 mg. per day
Tegretal Carbamazemine anti-seizure 100-300 mg
Tenex Guanfacine antihypertensive / behavior 1-2 mg
Tofranil Imipramine ADD/ADHD 10-100 mg.
Tylenol Acetominophen pain 325-650 mg. 4 hours
Ultrase enzymes cystic fibrosis 2-3 tabs per meal
Zyrtec Citirizine Allergic rhinitis 5-10 mg