1. Issues Related to Medication in the Schools Module 3

2. Greater numbers of school age children with chronic health conditions like Insulin Dependent Diabetes, seizures, feeding tubes, or life threatening allergies are attending public schools.

3. Issues Related to Medications The number of students with complex health conditions is increasing. In the past, many children with chronic illnesses attended a special school or did not go to school. Societal changes resulted in a focus on the health of children in Alabama schools.

4. Issues for Medications in School The goal of administering medicines to students is to promote optimal wellness in order to enhance their ability to learn. In Alabama the individual trained by the nurse to assist the student with medications will be known as the “Medication Assistant”. The Nurse Practice Act is the legal authority for defining appropriate standards of nursing. The nurse is accountable and responsible for the nursing care delivered to students under the nurse’s jurisdiction.

5. The RN or LPN School Nurse is required to have a license issued by the Alabama Board of Nursing. Nursing License—What Does it Mean?

6. What Difference Does a License Make? Specialized Knowledge Independent Judgment Training & Fitness to Practice

7. The Alabama Board of Nursing: – Regulates the nursing education programs in Alabama. –Assures that before issuing a license, the individual applicant meets all the legal requirements. –Assures that the applicant passes “state boards”---a national examination that determines the individual’s knowledge and competence to practice nursing. The holder of a nursing license is under the authority of the Board of Nursing. Alabama Board of Nursing

8. The Nurse Practice Act The Alabama Board of Nursing was established in 1915 by the Alabama legislature. The “Nurse Practice Act” is the term used to refer to the statutes that established the Board and the foundational laws for nursing practice. The Alabama Board of Nursing Administrative Code contains the published regulations.

9. Alabama Board of Nursing Administrative Code School nurse practice is very different than working in a hospital, nursing home, clinic, or home health. The school nurse is responsible for the health of children in each school to which he or she is assigned by the local education agency. Giving medicines is only one area of responsibility for the school nurse.

10. Delegation Delegation is defined in the Board of Nursing regulations. Chapter 610-X-2-.06 (2) states that delegation is “the act of authorizing a competent individual to perform acts supportive to registered nurses or licensed practical nurses in selected situations.” Delegation is a key issue because the licensed nurse retains responsibility for the task that is delegated to someone else---someone else performs the task but the nurse retains the responsibility for the outcome.

11. Delegation by School Nurses The school nurse is accountable and responsible for the nursing care delivered to students under the nurse’s jurisdiction. Registered nurses or licensed practical nurses that provide nursing care in the school setting through the twelfth grade may delegate specific tasks to unlicensed assistive personnel. The registered nurse is accountable for determining the tasks that may be safely performed by the unlicensed assistive personnel following appropriate training and demonstration of competency.

12. Delegation The task of providing prescribed oral,topical, ear, eye,nasal, and inhalation medications to students may be delegated to the unlicensed person when the following conditions have been met: The nurse identifies the appropriate individuals, to assist and the unlicensed person completes a minimum twelve hour course of instruction that includes a curriculum approved by the Board and demonstrates competency to perform the delegated task.

13. The school nurse shall provide periodic and regular evaluation and monitoring of the individual performing the delegated tasks. The school nurse shall routinely and periodically conduct quality monitoring of the tasks performed by the unlicensed assistive personnel, including, but not limited to: a.Training b.Competency c.Documentation d.Error reporting e.Methods of identification of the right student, the right tasks, the right method, and the right quantity at the right time. Delegation by School Nurses

14. The school nurse delegating the task may, at any time, suspend or withdraw the delegation of specific tasks to unlicensed assistive personnel. The SDE School Nurse Consultant or LEA School Nurse Administrator shall submit a report(s) to the ABN in a format specified by the Board upon request. Author: Alabama Board of Nursing. Statutory Authority: Code of Alabama, 1975, § 34-21- 2(c)(21). History: September 29, 1982. Repealed and Replaced: Filed October 29, 2001. Effective December 3, 2001. Suspending Delegation and Reporting

15. The Law The Law The Americans with Disabilities Act is a Federal Law that applies to children with physical disabilities, adults with learning disabilities,and children with mental disorders.

16. How other Agencies Impact Medications in schools How other Agencies Impact Medications in schools –Doctors are required to have a specific DEA number to write prescriptions for controlled substances. –The Alabama Board of Pharmacy has regulations regarding the dispensing, packaging, and distribution of medications by pharmacists and pharmacies. Board of Pharmacy regulations impact medicines in the schools---particularly field trips and off-campus events. –The Alabama Department of Public Health has regulations about reportable events, communicable diseases, and other public health issues.

17. Confidentiality/Privacy a)Health records are confidential and are kept separate from the school records. b) The medication assistant may need to know some information from the student health record if it is required in order to complete the medication task. c) Information provided to the medication assistant should not be repeated to other students,school employees,and teachers.

18. Health Information is Confidential! Access to medical records should be limited! Refer all release of information requests to the nurse. Use appropriate areas to administer medications, avoid public exposure. Disclosure of sensitive information could result in legal liability.

19. Responsibilities of the Medication Assistant a)ABA approved training for medication assistance by an unlicensed personnel. b)Training specific to LEA and school. c)Training in specific student issues d)Adheres to local policies and procedures. e)Follows the outlined plan of care for individual students which is developed by the nurse. Successfully Completes :

20. Responsibilities of the Medication Assistant: 1)Do not participate in activities that require: professional nursing judgment, knowledge, or skill 2) Notifies the school nurse when professional nursing care is required. 3) Notifies the school nurse immediately when there is --- suspicion of a medication reaction --- a medication error --- a change in the student’s health status 4)Completes timely, accurate documentation in accordance with state and local policies

21. No prescription medication may be given without: – parent authorization, –a healthcare provider order, and a –pharmacy label. Review local policies. Specific Rules Related to Prescription Medicine

22. Prescription Medication Must have: Student Name Physician Id Name of drug and strength Date Dose, Time, Route

23. Over –The Counter Medications Requires: Original container Student name Written parental permission To be delivered to school by parent or guardian.

24. Under no circumstances should the school stock over-the-counter (OTC) medicines, such as Tylenol, for student or staff use. OTC must be provided by the parent in the original container with specific instructions as to when or why such medicines may be necessary. Specific Rules Related to OTC Medicine

25. The delegating RN must evaluate and approve all OTC medicines and parental instructions. The delegating RN will determine if the OTC medicine is appropriate and whether a provider order is also necessary. Specific Rules Related to OTC Medicine

26. Use of the Six Rights: 1. right student 2. right medication 3. right dose 4. right time 5. right route 6. right documentation

27. Responsibilities Related to Controlled Substances Identifies controlled substances and stores in a secure location according to state and local policies. Documents the receipt, number, and return of controlled substances according to state and local policies. Reports discrepancies in the quantity of a controlled substance to the school nurse, principal and other authorities according to state and local policies.

28. Expected Outcomes for Students Remain in school, maintain or improve health status, and improve his/her potential for learning. Receive medication as prescribed by a licensed prescriber. Demonstrate knowledge of the principle of self-care and responsibility through appropriate self-medication procedures.

29. Thank – You Please follow with Module 4 and then take test. Information in this presentation was taken from the curriculum to teach unlicensed school personnel to assist with medications by the Alabama Board of Nursing and the Alabama State Department of Education.