Medication Administration For School Health Aides

Healthy Kids Learn Better Many kids require medications while at school so that they can be active participants in the classroom. “kids bring their whole life to school with them…and it doesn’t fit in a locker.”

Just a Little History… A federal mandate created in the 1970’s obligated schools to provide children with medical services, including medication administration. Medications that schools are asked to manage may include controlled substances, emergency and psychotropic medications, and a range of therapeutic interventions for chronic illnesses such as diabetes and asthma.

Training Each school principal must select regular and back up staff to be trained. Only trained staff can administer medication. The School Health Coordinator is responsible for providing training in the administration of medication to designated personnel at the beginning of each school year.

Staff Protection School staff are protected by law if careful observation of the regulations are observed: Florida Law states, “there shall be no liability for civil damages resulting from the administration of such medications where the person administering the medication acts as an ordinarily reasonably prudent person would have acted under the same or similar circumstances”.

Let’s begin… This presentation was developed to allow you to orient to medication administration at your convenience. You will be given a post test to take after you’ve viewed this presentation. Please leave the completed test for your School Nurse. Your School Nurse will check you off on the administration of all medication including the use of an EpiPen.

An “Authorization for Prescribed Medication” Form is required and should include: Child’s name Name of medication Date of Authorization Dosage How the medication should be given When the medication should be given Special instructions about the child or the medications Parent/guardian signature The amount of medication (pills, tablets, capsules) received and counted by parent and trained school staff

Non-Prescription or Over-the-Counter Medication Must have: An “Authorization for Prescribed Medication” form completed by parent/guardian Authorization Form approved by the School Nurse prior to medication administration Must be: Necessary for the child to remain in school FDA approved Non-alcohol based In the ORIGINAL CONTAINER Provided by the parent/guardian

Prescription Medication Requires written instruction by a doctor (prescription label meets this requirement). Must be prepared and labeled by a pharmacist. Must be in the original pharmacy container. Administered only if required during school hours. Must have a signed “Authorization for Prescribed Medication” form. New Authorization Form must be completed each year. This includes injectable drugs such as Insulin and EpiPen.

6 Rights of Medication Administration Right Student Right Medicine Right Dose Right Time Right Route Right Documentation

Right Student Don’t guess – Ask the student to tell you their full name (first and last). If a student is non-verbal or unable to tell you their name, ask a staff member who knows the student to verify that it is the correct student. If the student has a photo ID you can use that to verify.

Right Medication Read the student’s name aloud from the label and ask the student to verify again that this is their name. Check the Authorization for Prescribed Medication Form with the label on the medication container, making sure that: The student’s name on both are the same. The name of the medication on both are the same.

Right Dose Compare the dosage listed on the Authorization Form with the dosage listed on the container, making sure they agree. Note strength of medicine (i.e., 25 mg) and note amount to be given (i.e., 1 tab, ½ tsp.). Again compare what you have measured with the Authorization Form making sure they are the same. If any of the above do not agree DO NOT give the medication and call the School Nurse.

Right Time Compare the time on the Authorization Form with the actual time the medication is being given. A medication may be given a half hour before or after the time that it is ordered to be given by the doctor (grace period).

Right Route Compare the route listed on the Authorization Form with the label on the medication bottle. Oral (by mouth, swallowed – tablets, capsules, liquids) Topical (on the outside of the body – ointments, creams, eye drops, ear drops) If the route on the Authorization Form and the medication label are different – DO NOT give the medication and call the School Nurse.

Right Documentation Document in Health Office: on the correct student file after the medication has been given the actual time the medication was given the reason if a medication was given late or not at all Medication administration records are CONFIDENTIAL Access is limited to school staff with a “need to know” and parents

Safe Storage and Handling Store all medications in their original containers. NEVER administer medications from an unlabeled container. Store medications in a clean, locked cabinet.

Safe Storage and Handling (cont’d) Medication should be brought to school and returned home by a parent. DO NOT ALLOW STUDENTS to carry medications to and from home. Medications must be counted on arrival at school by parent and trained school staff and recorded on the Authorization Form. Changes in medication instructions requires a new Authorization Form be completed by parent.

Remember… You must get permission from the School Nurse prior to administering a new medication to a student. You must notify the School Nurse if there is a change in a medication order. Contact the School Nurse if you have ANY questions prior to giving the medication.

Medication Administration Do’s DO give your full attention to the task – verify each step. DO remain with the student until the medication is taken, make sure that oral medications are swallowed. DO prepare and administer medication for only one student at a time. DO allow parents to administer medication to their child if desired.

Medication Administration Don’ts DON’T give medication from a container which has a label that can not be read. DON’T give medication from another student’s container, even if they are the same. DON’T leave medication unattended. DON’T increase or decrease any medication without specific instructions. DON’T give a medication if there is any question about whether it is correct. Don’t crush or break tablets. Don’t open capsules.

What are Medication Errors? Dose not given Medication given to wrong student Inaccurate dose or wrong medication Wrong time Incorrect route

What you should do… Keep the student in the office with you. Assess the student’s status (Are you feeling okay? Is your heart racing, stomach hurting, etc.) IMMEDIATELY call the School Nurse and let the Principal know. The School Nurse will determine if Poison Control needs to be called. The School Nurse will notify the student’s parents. Complete a “Medication/Treatment Variance Report”.

Epinephrine Epinephrine is available in an auto injector called an EpiPen. Students who require the use of an EpiPen for a life threatening allergic reaction should carry this medication with them at all times.

When? Based on Student’s Symptoms signs of shock extreme paleness, gray color clammy skin loss of consciousness any other child-specific known symptom hives spreading over the body wheezing difficulty swallowing or breathing swelling in face or neck tingling or swelling of tongue

Steps in EpiPen Administration Take a deep breath. Have student lie down. Follow the 6 Rights of Medication Administration. If in a carrying case unscrew cap and remove EpiPen from tube. Grasp unit, with black tip pointing downward. Form fist around unit (black tip down). With your other hand, pull off the gray activation cap. Hold black tip near outer thigh. Swing and jab firmly into outer thigh at a 90 degree angle. (Designed to work through clothing). Hold firmly in thigh for approximately 10 seconds. Remove unit and massage injection area for 10 seconds. Call 911, seek medical attention and notify school administrator. Stay with student until help arrives. Document dose given in Health Office. *Return EpiPen into storage tube so that the student can take it with them to the emergency room.

Epinephrine Administration The EpiPen is administered into the large outer thigh muscle.

What next? Have someone notify the student’s doctor (on emergency card) regarding incident and where student is being transported. Notify parent/guardian regarding incident, student’s condition, and hospital destination. Document Student’s symptoms Location of injection Time of injection

Handling the 3 Most Common Unexpected Situations…

Student Does Not Come at Scheduled Time Send for student Document Notify: Teacher Parent Nurse

Student Refuses Medication Encourage Document Notify Parent Nurse

Student Vomits or Spits out Medication Document Notify Parent Nurse Check for symptoms of illness Fever Stomach Ache Headache Look for medicine in vomit…

What if… A parent brings in an antibiotic that the student was just prescribed and the mother requests that you start the medication as soon as possible. What do you do?

Right! Review and complete the “Authorization for Prescribed Medication” Form with the parent (don’t forget to count the medication). Explain to the parent that you must get permission from the School Nurse prior to administering the medication. However, you can… Allow the parent to administer the medication to their child until permission has been granted.

What if… The phone is ringing, the principal asked you to retrieve a file, a student is waiting for a pass, and the meds are due to be given. What do you do?

Good Job! Remain calm. Ask the students to have a seat. Answer the phone with a pleasant, “Hello this is ____, can I please put you on hold for a moment? Thank you.” Pull the chart for the Principal and call the office to let them know you’ve retrieved the chart. Could someone please come get it? Give the student a pass back to class. Answer the phone. Carefully administer the medications following the 6 rights of medication administration.

What if… After the meds have been given, you realize that you gave Jon Jensen’s medication to John Jones. What do you do?

You did it! Remember... Call John Jones to the Health Room. “All men make mistakes, but only wise men learn from their mistakes” – Winston Churchill Call John Jones to the Health Room. Assess John Jones’ status (is he feeling okay?). IMMEDIATELY call the School Nurse and let the Principal know. Complete a “Medication/Treatment Variance Report.

The End Thank you for all that you do. Don’t forget to take the post test and give it to your School Nurse. Don’t forget to get checked off on EpiPen. Have a peaceful day…

Prepared by: Kathleen Gross, MSN, RN School Nurse Levy County Health Department July 2009