Training Module Natomas Unified School District

 Policies and Procedures  Importance of proper medication administration  Types of medications administered in a school setting  The 6 Rights of proper medication administration  Standard Precautions related to the administration of medication  Forms Required for medication administration in school setting

* Participants completing this program will be able to:  Understand the importance of proper medication administration  Identify the requirements for proper medication administration  Recognize and apply the six (6) rights of medication administration

 Understand appropriate and correct documentation of medication administration  Use standard precautions during the administration of medication  Understand medical confidentiality as it relates to medication administration  Identify proper storage of prescription and over- the-counter medication

The goal of this program is to provide school staff with information about the student’s right to receive medication at school and responsibilities of the prescriber, school district, and school staff.

 More chronically ill and stable children are going to school with medications required to be taken some time while in school  Proper administration of medications can promote and support a child’s academic success  Proper administration of medications may help keep a child healthy and keep his or her chronic condition stable

* What is needed? The requirements for administering medication in school are the same regardless of the type of medication(over-the-counter or prescribed).

 Parents/guardians must provide:  Written statement (doctor orders) from authorized health care provider licensed in the State of California to prescribe medication  Written statement expressing their intent for the school to administer the medication

Each medication –prescription or over-the counter will be counted by designated school staff and parent/guardian:  Each time a medication is brought to school  Change in medication (return old prescription meds) The amount of pills, tablets, liquid…etc. will be documented on the Medication Count Log Inhalers and Epi-Pens will be counted and documented on the Medication Count Log

 All medication will be stored according to the manufactures instructions.  Each school site will have a designated, locked cabinet in the Health Office that is accessible to authorized staff.  The locked area will be kept clean and dry for the storage of medication.  Each student’s medications should be kept in a plastic container labeled with their name. The container should be locked in the medication cabinet.

 California-licensed physician and surgeon  California-licensed dentist  California-licensed nurse practitioner and California-certified nurse midwives  California-licensed physician assistants

* Request to Administer Medication at School from the parent/guardian contain the following:  Consent for authorized school staff to administer the medications  Agreement that the parent/guardian will provide the necessary medication, supplies, and equipment

 Agreement that the parent/guardian will notify authorized school staff if there is a change in student’s medication, health status or authorized health care provider  Sign the Medication Count Log each time a medication is brought to school

 Changes in medication, dose, time, and method of administration  Change in California authorized health care provider  Discontinuance of medication  Annually

 Student’s name and date of birth  Name of the medication and reason for administration  Amount or dose of the medication  If pill splitting is authorized, only scored pills may be split in half  Method of administration

 Time of administration at school  Possible side effects  PRN (as needed) order must contain specific symptoms that require the administration of the medication  Frequency of administration (every 4 hours)  Indications for referral for medical evaluation

 Statement from authorized health care provider that the student is competent to safely self-administer the medication  Name, address, telephone number, and signature of California authorized health care provider and stamp  Parent/guardian authorization

Do not guess:  Do not administer the medication  Notify the District nurse immediately

Acceptable written statement from authorized health care provider:  Physician’s order hand written or printed from private office or health care clinic OR NUSD printed forms:  Physician Request to Administer Medication at School used for medications/treatments other than Seizures, Diabetes, Allergies and Asthma

* Use the following for specific health conditions:  Asthma Management for the School Setting  Diabetic Medical Management Plan  Seizure Action Plan for the School Setting  Severe Allergies Action Plan for the School Setting

* Use this form all medication requests:  Request to Administer Medication at School – Parent/Guardian

 Antibiotics  Over-the counter medications  EMERGENCY  Epi-Pens  Glucagon  Quick-relief inhalers  Anticonvulsants  Insulin  Psychotherapeutic Agents: antidepressants, and antipsychotic  Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD )

 Oral (by mouth) tablets come in different forms: regular chewable, sublingual and scored  Topical – drops, ointments, and creams  Inhaler and Nebulizers –deliver a fine mist  Rectal  Injection

 Tablets unless otherwise ordered should be taken with at least 4 to 6 ounces of a liquid.  Scored tablets maybe cut into smaller pieces once  Enteric coated tablets should not be split or crushed  The coating dissolves in the intestine to prevent stomach irritation

 Chewable tables should be chewed before swallowing  Capsules are coated to dissolve in the stomach or intestine over a period of time  Swallow whole unless otherwise prescribed – do not break apart

 Oral medication should not be crushed without a licensed health care provider’s order (Doctor’s order)  Be sure the student swallows the medication

* Hand washing  Wash hands before and after giving medication/treatments  Disposable gloves  If contact with blood or bodily fluids is expected  Wash hands before and after putting gloves on  Dispose of gloves and other materials properly

 Unlabeled medication  Medication with incomplete instructions  Medication belonging to another student  Expired or discolored medication  If all six right have not been checked first  DO NOT - Return unused medication to prescription bottle

1. Right Person: Ask student for name, compare face to picture on container 2. Right Medication: Pharmacy label on medication bottle/container matches the Request to Administer Medication (physician orders) and the Medication Log 3. Right Dose: Compare the Medication Log with Pharmacy label and Request to Administer Medication (physician orders)

4. Right Time: Medication is give at the correct time – compare the Medication Administration Log, Pharmacy label, and The Request to Administer Medication (physician orders) 5. Right Route: Correct route is used – compare the Medication Administration Log, the Pharmacy label, and The Request to Administer Medication (physician orders) 6. Right Documentation: After the administration of the medication to the student: Document the name of medication, date, time, dose, and your initials on the student’s Medication Log

 Document the expiration date on the Medication Log  Check the expiration date of each medication prior to administration  Do not administer expired medication  Notify parent to pick up expired medication  Do not place expired medication in the trash or toilet

* A medication error occurs when a medication is not administered as prescribed  Examples of medication errors:  Omission  administration of a medication to wrong student  wrong dosage

 wrong time  wrong route  crushing a medication that shouldn’t be crushed  documentation errors – omission, wrong student

 Prepare medication for one student at a time  Give the medication to the student as soon as you remove it from container  Do not talk to others and ask them not to talk to you when you are giving medication  Do not stop to do something else in the middle of giving medication  Pay close attention at all times when you are giving medications

 Always compare the student’s name to the:  Pharmacy label  Request to Administer Medication (health care provider’s orders)  Medication Log

* Make sure all three forms match:  If they do not match, or if there is any doubt about whether you are giving the right medication to the right individual  STOP! Do not give the medication  Ask questions!!

 Do not send student to class, keep in Health Office and monitor for side effects of the medication  Follow the District’s Policy for reporting medication errors (AR (e))  Notify the site administrator  Notify the parent  Notify site District Nurse  Monitor the student for side effects  Complete Incident Report

* Each medication is documented when administered on the student’s Medication Log  School staff will document the:  Time, Date  Dose, Route  Initials of person administering medication

 Student refuses to take medication  Student is absent from school  Field trip  Wasted medication – pill dropped

 A student may not be prevented from going on a field trip due to medication administration  Arrangements for the administration of medication will be a coordinated effort with the parent by the site administrator, authorized school staff and the district nurse  Request for Medication Administration forms must be completed for all fieldtrips over-night as well as day trips.

* The Family educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of students and their educational records.  Health records maintained by school employees for Pre-Kindergarten through grade 12 are protected by FERPA  Information should be shared on a “need to know” basis

* National Association of School Nurses 8484 Georgia Ave #420 Silver Spring, MD * American Academy of Pediatrics 141 Northwest Point Blvd. Elk Grove Village, IL (847) * California Department of Education 1430 N Street Sacramento, CA