Ogden City School District Annual Medication Administration Training for School District Employees

Contents Why medications can safely be administered Utah Laws, District Policy and Procedures, Rules Accepting medications at school Authorization, Medication Containers Steps to follow to ensure safe administration Medication Errors Frequently asked questions and answers

Why medications can be safely administered at school. Medication administration in the school setting is governed by both federal and state laws. The laws are designed to: Protect a student’s right to access his/her medication. Protect the school district employee from liability.

Utah Law Medication Administration in the School Setting 53A‑11‑601.   Administration of medication to students ‑‑ Prerequisites ‑‑ Immunity from liability.   (1) A public or private school that holds any classes in grades kindergarten through 12 may provide for the administration of medication to any student during periods when the student is under the control of the school, subject to the following conditions: (a) the local school board, charter school governing board, or the private equivalent, after consultation with the Department of Health and school nurses shall adopt policies that provide for: (i) the designation of volunteer employees who may administer medication; (ii) proper identification and safekeeping of medication; (iii) the training of designated volunteer employees by the school nurse; (iv) maintenance of records of administration; and (v) notification to the school nurse of medication that will be administered to students; and (b) medication may only be administered to a student if: (i) the student's parent or legal guardian has provided a current written and signed request that medication be administered during regular school hours to the student; and (ii) the student's licensed health care provider has prescribed the medication and provides documentation as to the method, amount, and time schedule for administration, and a statement that administration of medication by school employees during periods when the student is under the control of the school is medically necessary. (2) Authorization for administration of medication by school personnel may be withdrawn by the school at any time following actual notice to the student's parent or guardian. (3) School personnel who provide assistance under Subsection (1) in substantial compliance with the licensed health care provider's written prescription and the employers of these school personnel are not liable, civilly or criminally, for: (a) any adverse reaction suffered by the student as a result of taking the medication; and (b) discontinuing the administration of the medication under Subsection (2).

Ogden City Schools Medication Administration Policy 8.24 MEDICATION AT SCHOOL 8.24.1 It is the policy of the Board of Education of Ogden City School District that administration of medication is the primary responsibility of the student or the student’s parent/guardian. However, the Board of Education recognizes that the health of a student may require assistance of administration of medication by authorized school personnel during the course of a school day. 8.24.2 It is the policy of the Board of Education of Ogden City School District that as long as authorized personnel act in a prudent and responsible manner, school or District staff who provide assistance in substantial compliance with the licensed medical provider’s written statement, are not liable civilly or criminally for any adverse reaction suffered by the student as a result of taking the medication, or discontinuing the administration of the medication.

Ogden City Schools Medication Administration Procedures (Page 1) A) ADMINISTRATION OF MEDICATION AT SCHOOL 1) Prescription and/or over-the-counter medication may be administered to a student only if: a. The student’s parent or legal guardian has provided a completed, current, signed and dated Authorization of School Personnel to Administer Medication form providing tor the administration of medication to the student during regular school hours. This request must be updated at the beginning of each school year and whenever a change is made in the administration of medication. b. The student’s licensed medical provider has also signed and dated the Authorization of School Personnel to Administer Medications” form stating the name, method of administration, dosage, time to be given, the side effects that may be seen in the school setting from the medication and the necessity for administering. c. The medication is delivered to the school by the student’s parent/guardian, or authorized adult. A one week’s supply or more is recommended. d. The prescription medication is in a container that has been property labeled by a pharmacy. e. The non-prescription, over-the-counter medication, is in the original container and clearly labeled with child’s name and dose, per doctor’s order on the container. A one week’s supply or more is recommended. f. The medication is an oral medication, inhalant medication, eye or ear drop medication, gastrostomy, rectal suppository, or topical medication, Epinephrine pen (Epi-pen) or insulin. Medications requiring other routes, i.e., IV and other injectable medications, cannot be administered by school personnel. The exception of an I.M. Glucagon may be administered by a volunteer who has been trained and authorized by the district nurse as part of the student’s Diabetes Health Care Plan for school. 2) Prescription and/or over-the-counter medication specified in a student’s IEP or 504 accommodation plan will be administered as outlined in the accommodation plan.

Ogden City Schools Medication Administration Procedures (Page 2) 3) The school will do the following: a. Designate a staff member to administer medication and notify the school nurse of medication needs. b. Arrange annual training with the school nurse for designated personnel. This training will include: i. How to properly administer medication(s). ii. Indications for the medication(s). iii. Dosage and time of medications(s). iv. Adverse reactions and side effects of medication(s). v. Proper maintenance of records. vi. Designated staff, including teachers in charge of field trips, will receive medication administration training. c. Designated personnel have the responsibility to administer medication to all students with a written physician’s medication order. If a medication is repeatedly refused, the parent/guardian must be notified. d. Any adverse reactions or medication errors will be reported promptly to the parent/guardian. If the parent is unavailable, the student’s doctor will be called for further direction. This adverse reaction or medication error must be documented on the Medication Error/Adverse Reaction Reporting Form.

Ogden City Schools Medication Administration Procedures (Page 3) 3) The school will do the following: (continued) e. Maintain records regarding administration of medication. i. Each student must have his/her own record which includes an Authorization of School Personnel to Administer Medication and the Medication Administration Record. ii. The Medication Administration Record will show authorized initials of designated staff when medication is administered. All boxes must contain initials of staff administering medication or reason for medication not given. iii. The Medication Administration Record will show medication, dosage, time of day, and date. It will show when and how much medication has been delivered to the school by the parent. It will also show how much medication has been discarded (if necessary) and who witnessed the disposal. iv. The “Medication Administration Record” will be available to be viewed by parent/guardian upon request. v. The medication documents will be placed in an appropriate file at the end of each year. f. Provide a secure location for the safekeeping of medications. i. Medication to be administered by school staff must be stored in a locked cabinet or secure refrigerated unit. ii. Unused medication(s) should be picked up within two weeks following notification of parents/guardians, or it will be disposed of by the school and recorded on the Medication Administration Record. In disposing of Ogden City School District Policy & Procedure medication, two people must be present to record the medication, the amount of medication discarded, date, and how discarded. iii. Both witnesses must sign the Medication Administration Record.

Ogden City Schools Medication Administration Procedures (Page 4) 4) Authorization for administration of medication by school personnel may be withdrawn by the school at the school’s discretion any time after notification to the parent/guardian. Among the circumstances under which authorization may be withdrawn are the following: a. The parent/guardian has been non-compliant with the Medication Policy; or b. The student has been non-compliant with the Medication Policy by: i. Refusing medication repeatedly; or ii. Continued resistance to coming for medication at the appointed time.

Ogden City Schools Medication Administration Procedures (Page 5) 5) The withdrawal of medication for students on 504 accommodation plans or an IEP can occur only after a meeting with the parents has taken place. B) STUDENT SELF-ADMINISTRATION 1) Students in kindergarten through grade 6 may not self-administer medications except for asthma inhalers, epinephrine, or insulin. Inhalers may be carried on the person. Inhalers, epinephrine, and insulin may be administered by the student in elementary school if the parents and medication provider sign and return the forms to self-administer inhalers and insulin. 2) Students in grade 7 through grade 12 may carry one day’s dosage of their medication on their person. Inhalers may be carried on the person. Inhalers, epinephrine, and insulin may be administered by the student if the parents and medical provider sign and return the form to self-administer inhalers, epinephrine, and insulin. 3) Any misuse of such medication by the student may be subject to disciplinary action under the District’s Safe Schools Policy.

Other Rules In addition to Utah Law 53A-11-601 and Ogden City School District Policy 8.24, medication administration in the school setting is governed by the Utah Nurse Practice Act R156-31b-701a

Utah Nurse Practice Act R156-31b-701a R156-31b-701a. Delegation of Nursing Tasks in a School Setting. In addition to the delegation rule found in Section R156-31b-701, the delegation of nursing tasks in a school setting is further defined, clarified, or established as follows: (1) Any task being delegated by the school nurse shall be identified within a current IHP. The IHP is limited to a specific delegatee for a specific time frame. Any unlicensed person who administers medication to a student as a delegatee of a school nurse, must receive training from a school nurse at least annually. (2) The action of a medication shall determine if the drug is appropriate to delegate the administration to an unlicensed person. Any medication with known, frequent side effects that can be life threatening shall not be delegated. (3) Medications that require the student's vital signs or oxygen saturation to be monitored before, during or after administration of the drug shall not be administered by an unlicensed person. (4) A nurse working in a school setting may not delegate the administration of the first dose of a new medication or a dosage change. (5) A nurse may not delegate the administration of any medication which requires nursing assessment or judgment prior to or immediately after administration. (6) The routine provision of scheduled or correction dosage of insulin and the administration of glucagon in an emergency situation, as prescribed by the practitioner's order or specified in the IHP: (a) are not actions that require nursing assessment or judgment prior to administration; and (b) may be delegated to a delegatee. Insulin and glucagon injections by the delegatee shall only occur when the delegatee has followed the guidelines of the IHP.

Annual Medication Training for Employees of Ogden City School District All employees, designated by the school principal to administer medications, must receive this annual training.

Accepting Medications at the School Before accepting any medication at the school, Ogden City School District staff will: Receive the Authorization for School Personnel to Administer Medications form for each medication brought. This form must be updated each school year. Forms from the previous school year are not valid. All blank spaces in this form should be completed. This form MUST be signed by both parent/guardian AND the student’s physician. The medication must be in the original medication container that is labeled by the pharmacist. (This includes both prescription and over-the-counter medications.)

Authorization for school personnel to administer medication All spaces must be completed. New form for each school year. One form for each medication. Forms can be found on Ogden City School District website. It is the responsibility of the PARENT/GUARDIAN to have this form completed and signed by the physician.

Containers All medication must be labeled by pharmacist. This includes non-prescription (over the counter) medications. Label must include: medication name student name dose Frequency/time expiration date

Safety Properly Labeled NOT Properly Labeled

How to ensure safe medication administration The 6 RIGHTS to medication administration Before giving any medication, ask yourself…. Is this the right student? Is this the right medication? Is this the right dose? Is this the right time? Is this the right route? Have I got the right documentation?

Medication Administration Record Document EVERY medication administered. Federal and State law impose restrictions on student health records. Medication Administration Records are considered confidential information. Please keep medication records separate from the student’s CUM file. Always forward copies district nurse.

When giving pills, tablets, or capsules… Always wash your hands first. Identify student by asking them to state their name. Select the correct medication. Check both the label on the bottle and the Authorization for School Staff to Administer Medication form. Pour the pill into the cap of the bottle, then pour it into the student’s hand. Watch the student until the medication is safely swallowed. Document the medication administration on the Medication Administration Record.

When giving liquid oral medications…. Always wash your hands first. Identify student by asking them to state their name. Select the correct medication. Check both the label on the bottle and the Authorization for School Staff to Administer Medication form. Poor the medication into the measuring cup (provided by parent). Watch the student until the medication is safely swallowed. Document the medication administration on the Medication Administration Record.

Asthma Medications Students who have medications to treat asthma at school, should have an Asthma Plan for School and an Asthma Medication Self-Administration Form. These forms will identify when a student needs medication, how often a student is permitted to take the medication, and what medication can be taken.

Inhalers Always follow the Asthma Plan for School. 1. Shake then prime the inhaler by depressing the canister once before the student uses it. 2. Have student blow out breath. 3. Place inhaler in mouth 4. Press inhaler down once while student breathes in slowly. 5. Have student hold breath for 10 seconds then breathe out slowly. Repeat once ,if indicated, on the Asthma Plan for School

Use of Inhaler with a Spacer 1. Shake and prime the medication before giving it. 2. Insert the mouthpiece into the end of the spacer. 3. Have the student breathe out. 4. Place the other end of the spacer in mouth and make a tight seal with lips. 5. Press the inhaler down once to trap the medication in the spacer. 6. Have student breathe in slowly and deeply. 7. Have student hold breath 5-10 seconds then breathe out slowly. Repeat once ,if indicated, on the Asthma Plan for School

Medications for Allergic Reactions Students who have a potential for severe allergic reactions may have medications at the school. In addition to medication forms, parents should complete a health plan to help staff identify when the student may need medication. For students with food allergies, parents may also request a Special Meal Accommodation Form. The district nurse can help you to find the correct forms for different types of allergies.

Use of Epinephrine There are many different types of epinephrine delivery devices. Please contact your school nurse to request a demonstration on the types of epinephrine at your school. Always call 911 if epinephrine is administered.

Other Types of Medication Delivery… Glucagon Injections* Insulin via Pumps, Pens, and Syringes* Emergency Medications for Seizures (Nasal, Suppository, G-Tube)* *These medications can be safely given to students at school, but all require specialized training and authorization. Please contact a district nurse to schedule a separate training.

Medication Storage Medication must be kept in a locked area. Emergency medications must be easily accessible to all trained staff. Diabetes medications, Epinephrine, and Asthma medication may be carried by the student with the proper authorization. Emergency medications should be carried by a trained teacher/staff on field trips. Scheduled medications may need to be carried and administered by a trained teacher/staff if field trip occurs when medication is due. Medications may be kept in the school office, in the classroom, or in the Special Education classroom as long as it is stored in a safe and locked area. (It is not recommended for teachers to keep medications in their classrooms unless other trained staff have access to the area that the medication is kept.)

Medication Errors or Adverse Reactions Mistakes can be made when giving medications to students such as wrong medication, wrong dose, wrong time, or wrong student. Sometimes a student may have an adverse reaction to a medication that was given correctly. If this happens, it’s important to report this information to parents and the district nurse. A Medication Errors/Adverse Reaction form should always be completed. Always call 911 if you notice a severe adverse reaction including respiratory distress, chest pain, uncontrolled vomiting/diarrhea , or involuntary muscle movements.

Frequently Asked Questions and Answers Q What if the student does not come to the office to take his/her daily medication? A It is the responsibility of the designated school employee to assure medications are given at the time prescribed. If a student is non-compliant (or doesn’t remember) to take medication, additional steps should be taken to solve the problem. Please contact a district nurse for assistance. Q What if the student only needs medication administered for a short period of time? (Example: 10-day course of antibiotics) Do the parents still have to complete the authorization form? A Yes. All medications administered by a school district employee MUST have authorization. Q Can a student administer his/her own medication without authorization? A No. All students K-12 may administer their own asthma medications, diabetes medications, and Epinephrine only when the authorization forms are complete. Q How do I contact a district nurse?

District Nurses Contact Information Office Fax Number 801-737-8515 District Nurse Telephone (Office) Telephone (Cell) E-Mail Sheena Robinson 801-737-8830 801-430-8830 robinsons@ogdensd.org Mitzi Chrisoffersen 801-737-8826 801-430-4280 christoffersenm@ogdensd.org Tina Skerl 801-737-8825 801-430-4281 skerlt@ogdensd.org

Things to remember… Never accept medication without the proper authorization. Never accept medication without the proper labeling. Never give a medication when the authorization form does not match the label on the bottle. All medication forms can be found on the district nurse website. Always call the district nurse if you have questions about medication administration.

The End Thank you for completing the Annual Medication Administration Training Program. Please complete the Annual Medication Training Certification form and send a copy to the District Nurses Office.

Annual Medication Training Certification form