Medication Administration

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Medication Administration

• For School Health Aides

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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
  themand it doesnt fit in a locker.

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Just a Little History

• A federal mandate created in the 1970s 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.

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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.

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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.

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Lets 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
  youve 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.

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An Authorization for Prescribed Medication Form
is required and should include

• Childs 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

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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

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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.

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6 Rights of Medication Administration

• Right Student
• Right Medicine
• Right Dose
• Right Time
• Right Route
• Right Documentation

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Right Student

• Dont 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.

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Right Medication

• Read the students 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 students name on both are the same.
• The name of the medication on both are the same.

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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.

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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).

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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.

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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

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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.

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Safe Storage and Handling (contd)

• 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.

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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.

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Medication Administration Dos

• 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.

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Medication Administration Donts

• DONT give medication from a container which has
  a label that can not be read.
• DONT give medication from another students
  container, even if they are the same.
• DONT leave medication unattended.
• DONT increase or decrease any medication without
  specific instructions.
• DONT give a medication if there is any question
  about whether it is correct.
• Dont crush or break tablets.
• Dont open capsules.

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What are Medication Errors?

• Dose not given
• Medication given to wrong student
• Inaccurate dose or wrong medication
• Wrong time
• Incorrect route

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What you should do

• Keep the student in the office with you.
• Assess the students 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 students
  parents.
• Complete a Medication/Treatment
  Variance Report.

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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.

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When? Based on Students 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

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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.

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Epinephrine Administration

• The EpiPen is administered into the large outer
  thigh muscle.

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What next?

• Have someone notify the students doctor (on
  emergency card) regarding incident and where
  student is being transported.
• Notify parent/guardian regarding incident,
  students condition, and hospital destination.
• Document
• Students symptoms
• Location of injection
• Time of injection

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• Handling the 3 Most Common Unexpected Situations

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Student Does Not Come at Scheduled Time

• Send for student
• Document
• Notify
• Teacher
• Parent
• Nurse

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Student Refuses Medication

• Encourage
• Document
• Notify
• Parent
• Nurse

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Student Vomits or Spits out Medication

• Document
• Notify
• Parent
• Nurse
• Check for symptoms of illness
• Fever
• Stomach Ache
• Headache
• Look for medicine in vomit

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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?

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Right!

• Review and complete the Authorization for
  Prescribed Medication Form with the parent
  (dont 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.

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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?

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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 youve 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.

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What if

• After the meds have been given, you realize that
  you gave Jon Jensens medication to John Jones.
• What do you do?

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You did it!

• Remember...
• 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.

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The End

• Thank you for all that you do.
• Dont forget to take the post test and give it to
  your School Nurse.
• Dont forget to get checked off on EpiPen.
• Have a peaceful day

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