Medication Administration Annual Review

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Medication Administration


Annual Review

• A Training for School Personnel February 2007
• Revised June 2008

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Welcome to KCSD annual medication
administration re-training. This program contains
information required by law to administer
medications to school students. In order to
complete this training, you must have previously
attended a course presented by one of the
nurses. Please read all of the information and
complete the quiz. Following the quiz, there is a
survey. This information is required and will
assist in improving this course and developing
others. You must include your name, building, and
date. This information is required for our
records. If this is your first time completing
this course, allow 1/2 hour to do so. Next
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Goal

• This training is intended for non-nurse school
  staff who have been assigned to give medications
  in school, following the legal guidelines of ORS
  339.867 to 339.870 and OAR 581-021-0037.
• Next Back

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The Law

• Administrative rules were adopted by the Oregon
  Department of Education in 1997, and amended by
  the legislature in 2007.
• School districts must adopt policies and
  procedures for this rule including policies which
  address student self medication.

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What the Law Says

• Administrator must select regular and back up
  staff
• Designated school personnel are REQUIRED to
  receive training annually
• ONLY trained staff can administer medication
• Training program must be approved by Oregon
  Department of Education

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Oregon Dept of Education

• Initial training must occur face-to- face with a
  nurse
• Annual retraining can be completed online

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Note

• Only non-injectable medications are covered by
  this law
• Nebulizer treatments, injections and rectal
  medication administration will not be taught in
  this training

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Three Types

• Non-prescription medication
• Prescription medication
• Student self-administered medications

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Non-Prescription Medication

• Commercially prepared
• Original container
• Non-alcohol based
• Necessary for student to remain in school
• Includes cough drops and antacids (e.g. Tums)

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Non-Prescription Medication

• Require
• Written parent permission instructions
• Can be faxed
• Student name
• Medication name
• Medication dosage, frequency, route
• Must provide own medication

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Prescription Medications

• Law requires school personnel to be responsible
  only for prescription medication scheduled to be
  given during school hours.

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Prescription Medication

• Does not include injectable drugs
• Must be prepared and labeled by a U.S. pharmacist
  and be in the original pharmacy container

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Prescription Medication

• Requires written instruction from a physician
• Prescription label meets this requirement
• Requires signed permission and instruction from
  parent
• Medication Permission Form
• New medication permission form must be completed
  each year
• Administered only if required during school hours

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These People Can Write Orders

• Doctor of medicine/osteopathy/naturopathy
• Physician assistant
• Nurse practitioner
• Dentist
• Optometrist

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Student Self-Medication

• Student must be able to carry and self-medicate,
  without assistance
• No staff documentation necessary
• Must be in original container
• May only carry one days supply at a time

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Self-Medication Changes for
2008-2009

• Can self-medicate at all schools
• Requires Self-Medication Permission Form
• Requires medical order
• Only for prescription medication
• Can be on the label
• Requires principal permission
• Can be revoked
• Requires parent to provide back-up inhalers
  EpiPens to be kept in the office

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Routes of Medication

• Oral
• Tablets, capsules, elixirs or suspensions
• Topical
• Skin, eyes, ears, nose
• Inhaled
• Mouth or nose

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Oral Medication

• Oral medicine should be followed with water
• Obtain water from a clean source
• Do not obtain water from sink where first aid
  provided

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Oral Medication

• Tablets requiring cutting should be cut at home
  and sent to school
• Parents should provide pill crusher if pills need
  to be crushed
• Have parents provide calibrated spoon/cup if
  needed for liquid medication

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Topical Medication Ointments

• Apply to a clean surface
• Do not apply with your bare hands
• Use a cotton tipped applicator or gauze pad to
  apply medication

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Topical Medication
Eye Drops/Ointment

• Administer with student laying down or head
  tilted back
• Apply drops or ointment without touching
  container to eye or skin
• Do not administer directly to eyeball
• Apply to inner portion of eye, close to nose

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Topical Medication
Ear Drops

• Lay child on side opposite of ear you are
  medicating
• While gently pulling up and back on ear, instill
  correct number of drops
• Do not touch tip of container to ear or skin
• Leave child on side for a short time

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Topical Medication Nose
Drops

• Have student lay with head back over a rolled
  pillow
• Instill drops in nostril
• Keep student in this position for a few minutes
• Observe for signs of choking or vomiting

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Inhaled Medication

• Student should be capable of self-administering
  inhaler
• If student continues to experience difficulty
  breathing 5 minutes after using inhaler
• Call parent and/or 9-1-1

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Five Rights

• Right student
• Always ask the students name
• Right medication
• Check the label
• Right dose
• Check the label
• Right time
• Can be given 30 min before or after the time
  stated on the label
• Right route
• Check the instruction on the label

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Safe Storage and Handling

• Store medications in a clean, locked cabinet
• NEVER administer medications from an unlabeled
  container
• Narcotics, stimulants, and barbiturates should be
  counted upon arrival at school
• May be counted with parent or trained school
  staff
• Check with district nurse if you are unsure

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Safe Storage and Handling

• Medication should be brought to school and
  returned home by the parent. Do not allow
  students to carry medications home
• Changes in medication instructions must be made
  by parent and/or physician in writing. DO NOT
  act on verbal requests
• Only a licensed nurse can take verbal orders from
  a physician

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Safe Storage and Handling

• Refrigeration is necessary for some medications
• Many liquid medications need to be shaken well
• Beginning 2008-2009 refrigerated meds need to be
  locked
• District will provide lock boxes

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Handling Medications

• Always wash your hands
• Avoid touching medication
• Wear gloves if placing medication in students
  mouth

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Handling Medications

• Do Not leave meds unattended
• Prepare for one student at a time
• Compare medication label with Medication Log

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Disposal of Medication

• Notify parent of unused medication
• Any unclaimed medication should be placed in
  sealable container in the presence of two staff
  members
• Prescription Medication must be counted and the
  number of pills documented
• Bring sealed container to DO during secretary
  check-out
• Note parent contact and medication disposal on
  Medication Log sign by both staff members

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Record Keeping

• Legal document
• Ink
• Students legal name and DOB
• Medication Permission Form
• Medication Log
• Sign initials in log right after giving

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Record Keeping

• Only one student on each form
• No white-out
• If an error is made
• Put a single line through it
• Initial and date it
• If there is a dose change
• Begin a new line on the Medication Log

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Retaining Medication Records

• Send completed forms to the DO
• If medication is complete
• The student moves
• At the end of the school year
• They will be filed in Student Health Folder
• In SpEd file if student has an IEP

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Three Most Common Unexpected Situations

• Student does not come at scheduled time
• Student refuses medication
• Student vomits or spits out medication

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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
• Check for symptoms of illness
• Fever
• Stomachache
• Headache

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Side Effects Allergic Reactions

• All medication can cause side effects or allergic
  reactions
• Know where EpiPens are kept and who is certified
  to use them
• Teachers should be aware of students taking
  medication
• Report promptly any unusual symptoms or behaviors
  to district nurse and parent

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Prevent Errors

• Take your time
• Do not allow yourself to be rushed
• Work with one student at a time
• Always follow the 5 rights
• Record medication immediately after giving on the
  Medication Log

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What Are Medication Errors?

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

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Medication Errors

• Accidents Happen
• Report medication errors immediately to district
  nurse and building administrator
• Nurse will contact parent
• Complete Accident/Incident Analysis

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Field Trips and Off- Campus
Activities

• PLAN AHEAD!
• Staff person trained in medication administration
  must accompany group if medications will be
  required
• Document administration on a copy of the
  Medication Log while on field trip and on the
  original when you return
• Recommend notifying nurse two weeks prior to trip
  if medication training is necessary

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Field Trip Supplies

• Copy of Medication Log
• Medication in original container
• Hand cleaner
• Drinking water
• Safe container to transport

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Confidentiality

• Student medication files are CONFIDENTIAL
• Access limited to school staff with a legitimate
  need to know
• Parent/Guardian authorization is required for
  release of information

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Remember!

• Once KCSD has received a signed permission slip
  and medication, it is our responsibility
• To administer it appropriately and on time (30
  mins before or after time on prescription)
• Monitor medication supply

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Parent Communication

• Avenues of communication to parents
• Registration
• Student Handbooks
• School Newletters
• Informational Packets

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Dealing with Concerned Parent

• Validate parent emotions
• Remind them - student safety is the priority
• Share written information
• Include district nurse and administrator
• Set boundaries and ensure your own safety

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Establishing a Cooperative School Environment

• Success requires a team effort
• Include teacher in planning students medication
  needs

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Staff Protection

• School staff are protected by careful observation
  of regulations of the medication law, rules,
  district policy
• Nurses responsibility is to provide proper
  training
• Your responsibility is to follow the instruction

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Remember!

• NO Baggies
• NO Envelopes
• NO Medication Boxes

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If you have any questions or concerns call a
nurse before giving the medication
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Medication AdministrationQuiz
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Question 1

• Never give medication sent to school in a baggie.
• True
• False

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Correct

• All medication must be in the original container
  properly labeled with the name of the student,
  name of the medication, dose, route, and
  frequency of administration.
• Next question

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Incorrect

• Law states all medication must be in the original
  container properly labeled with the name of the
  student, name of the medication, dose, route, and
  frequency of administration
• Back

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Question 2

• If a parent calls saying the doctor has increased
  the dose from one pill to two, always follow the
  parents instructions.
• True
• False

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Incorrect

• Medication must be given as directed on the
  prescription label. Written instructions from the
  doctor or a new prescription label are required
  to change the dose.
• Back

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Correct

• Medication must be given as directed on the
  prescription label. Written instructions from the
  doctor or a new prescription label are required
  to change the dose.
• Next question

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Question 3

• Once a staff member has been trained to give
  medication by the nurse, they only need more
  training if the laws regarding medication
  administration change.
• True
• False

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Incorrect

• Oregon law states yearly instruction must be
  provided to designated school staff on the
  administration of medication.
• Back

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Correct

• Oregon law states yearly instruction must be
  provided to designated school staff on the
  administration of medication.
• Next question

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Question 4

• A good way to assure the appropriate students
  receive their medication each day is to keep a
  list on the cabinet or refrigerator
• True
• False

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Correct

• Student medication information is confidential
  and should be shared only with staff who have a
  legitimate need to know
• Posting such information where students, parents,
  general staff can view it is a breech of
  confidentiality
• Next question

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Incorrect

• Student medication information is confidential
  and should be shared only with staff who have a
  legitimate need to know
• Posting such information where students, parents,
  general staff can view it is a breech of
  confidentiality
• Back

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Question 5

• Alcohol-based cough syrup can be given at school
  with written permission from a parent
• True
• False

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Incorrect

• The law defines non-prescription medication as
  commercially prepared, non-alcohol based
  medication to be taken at school that is
  necessary for the child to remain in school. This
  includes eyes, nose and cough drops, cough
  suppressants, analgesics, decongestants,
  antihistamines, topical antibiotics,
  anti-inflammatories and antacids that do not
  require written or oral instructions from a
  physician. Non-prescription medication does not
  include dietary food supplements
• Back

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Correct

• The law defines non-prescription medication as
  commercially prepared, non-alcohol based
  medication to be taken at school that is
  necessary for the child to remain in school. This
  includes eyes, nose and cough drops, cough
  suppressants, analgesics, decongestants,
  antihistamines, topical antibiotics,
  anti-inflammatories and antacids that do not
  require written or oral instructions from a
  physician. non-prescription medication does not
  include dietary food supplements.
• Next question

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Question 6

• If a parent sends a pill bottle with the students
  name on it to school and keeps the original pill
  bottle at home, it is OK to give the medicine.
• True
• False

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Correct

• Prescription medication must be in the original
  container with a pharmacy label attached
• Only a licensed pharmacist can legally package
  and label medication
• Next question

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Incorrect

• Prescription medication must be in the original
  container with a pharmacy label attached
• Only a licensed pharmacist can legally package
  and label medication
• Back

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Question 7

• When a parent asks you to give their child two
  Childrens Tylenol for a headache, it is OK to do
  so if you have the medicine.
• True
• False

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Correct

• Oregon law requires written permission and
  instruction from the students parent to
  administer non-prescription medication
• It is the parents responsibility to provide a
  students medication
• Next question

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Incorrect

• Oregon law requires written permission and
  instruction from the students parent to
  administer non-prescription medication
• It is the parents responsibility to provide a
  students medication
• Back

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Question 8

• When the trained medication person is absent, the
  principal can have another staff member give
  medicine even if they have not been trained.
• True
• False

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Incorrect

• Law states school staff designated to administer
  medication must receive yearly training
• Back

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Correct

• Law states school staff designated to administer
  medication must receive yearly training
• Next question

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Question 9

• Any student can carry and administer their own
  non-prescription medication if their parent
  writes it on the permission slip.
• True
• False

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Incorrect

• Any student may carry and self-medicate
  non-prescription medication with
• Written parental permission Self-Medication
  Permission Form
• Principal permission
• Medication must be in original container
• Student may only carry one days supply of
  medication at a time
• Back

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Correct

• Any student may carry and self-medicate
  non-prescription medication with
• Written parental permission Self-Medication
  Permission Form
• Principal permission
• Medication must be in original container
• Student may only carry one days supply of
  medication at a time
• Next question

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Question 10

• Students may carry and self-administer cough
  drops as long as their parent sends them with the
  student
• True
• False

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Correct

• Cough drops and antacids (e.g. Tums) are
  considered non-prescription medication and
  require
• Student to provide their own medication
• Written parental permission instructions to
  include
• Student name
• Medication name
• Medication dose, frequency, route
• Next question

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Incorrect

• Cough drops and anti-acids (Tums) are considered
  non-prescription medication and require
• Student to provide their own medication
• Written parental permission instructions to
  include
• Student name
• Medication name
• Medication dose, frequency, route
• Back

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Question 11

• All medication should be stored in a clean,
  locked cabinet.
• True
• False

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Correct

• All medication should be stored in a clean,
  locked cabinet
• Refrigerated medication must be stored in a
  locked container in the refrigerator
• Next question

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Incorrect

• All medication should be stored in a clean,
  locked cabinet
• Refrigerated medication must be stored in a
  locked container in the refrigerator
• Back

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Question 12

• If a student vomits after taking their
  medication, be sure to send a note home to the
  parent.
• True
• False

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Incorrect

• If a student vomits after taking their medication
• Document
• Observe for signs of an allergic reaction
• Check for signs of illness
• Contact parent
• Back

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Correct

• If a student vomits after taking their medication
• Document
• Observe for signs of an allergic reaction
• Check for signs of illness
• Contact parent
• Next question

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Question 13

• When an eighth grade student does not come for
  their medication, it is their own problem they
  are old enough to be responsible.
• True
• False

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Incorrect

• Once we have received medication and a signed
  permission slip from a parent, we are responsible
  for getting the medication to the student within
  ½ hour of the designated time
• If a student does not come for scheduled
  medication
• Send for the student
• Back

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Correct

• Once we have received medication and a signed
  permission slip from a parent, we are responsible
  for getting the medication to the student within
  ½ hour of the designated time
• If a student does not come for scheduled
  medication
• Send for the student
• Next question

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Question 14

• When a student requiring medicine is going on a
  field trip, put their pills in a zip-lock bag
  with the students name and instructions, and give
  them to the teacher.
• True
• False

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Incorrect

• Prescription medication must be in its original
  container with a proper pharmacy label attached
• non-prescription medication must be in its
  original container, labeled with the students
  name
• Anyone dispensing medication at school must
  receive annual, ODE approved training.
• Back

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Correct

• Prescription medication must be in its original
  container with a proper pharmacy label attached
• non-prescription medication must be in its
  original container, labeled with the students
  name
• Anyone dispensing medication at school must
  receive annual, ODE approved training.
• Next question

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Question 15

• A student is given the wrong medication in error.
  The best thing to do is make the student vomit
  the medicine.
• True
• False

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Incorrect

• Never induce vomiting
• Medication errors must be reported to the nurse
  immediately
• Medication errors include
• Failing to give a dose
• Giving medication to the wrong student
• Giving medication at the wrong time
• Giving the wrong medication or the wrong dose
• Giving the medicine by the wrong route
• If a nurse is not immediately available, you may
  call Poison Center 1-800-222-1222.
• Back

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Correct

• Never induce vomiting
• Medication errors must be reported to the nurse
  immediately
• Medication errors include
• Failing to give a dose
• Giving medication to the wrong student
• Giving medication at the wrong time
• Giving the wrong medication or the wrong dose
• Giving the medicine by the wrong route
• If a nurse is not immediately available, you may
  call Poison Center 1-800-222-1222
• Next question

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Question 16

• Teachers should know when their students are
  taking medication, in spite of confidentiality
  laws.
• True
• False

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Correct

• Teachers have a legitimate educational interest
  in students taking medications
• All medication has the potential to cause side
  effects
• All medication has the potential to cause an
  allergic reaction
• Next question

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Incorrect

• Teachers have a legitimate educational interest
  in students taking medications
• All medication has the potential to cause side
  effects
• All medication has the potential to cause an
  allergic reaction
• Back

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Question 17

• Always use pencil when recording medications so
  that you can make changes if a mistake is made.
• True
• False

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Incorrect

• Medication records are legal documents
• Must be written in ink
• When you write on the medication log, initial
  what you have written
• If your initials are on the log, place your
  initials and signature in the appropriate spot on
  the bottom of the log
• Back

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Correct

• Medication records are legal documents
• Must be written in ink
• When you write on the medication log, initial
  what you have written
• If your initials are on the log, place your
  initials and signature in the appropriate spot on
  the bottom of the log
• Next question

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Question 18

• At the end of the year, send all of the
  medication logs to Health Services at the DO.
• True
• False

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Correct

• Send completed Medication Logs to the DO
• If the medication is complete
• The student moves
• At the end of the school year
• Next question

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Incorrect

• Send completed Medication Logs to the DO
• If the medication is complete
• The student moves
• At the end of the school year
• Back

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Question 19

• When the prescription label says to give the
  medicine at 1200 and lunch is at 1145, it is OK
  to give before lunch.
• True
• False

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Correct

• Medication is to be given within ½ hour before or
  after the designated time
• Next question

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Incorrect

• Medication is to be given within ½ hour before or
  after the designated time
• Back

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Question 20

• The 5 Rights of Medication Administration
  include
• Right Student
• Right Medication
• Right Dose
• Right Time
• Right Route
• True
• False

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Correct

• If the person administering the medication always
  follows the 5 Rights, it is unlikely an error
  will occur.

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Incorrect

• Right Student-always ask their name, even if you
  know them
• Right Medication-read the prescription label and
  compare it to the medication log
• Right Dose-give the exact amount specified by the
  physician on the label
• Right Time-check the medication log for the time
  it is to be given. Up to 30 minutes before or
  after the prescribed time is OK
• Right Route-always check the label which will
  tell you if it is to be taken by mouth, rubbed on
  the skin, or put in an ear
• Back

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References

• Oregon Department of Education.
  www.ode.state.or.us/groups/supportstaff/hklb/schoo
  lnurses/medicationadmin.pdf Accessed April
  21,2007.
• Oregon Administrative Rules, Chapter
  581-021-0037. Administration of Prescription and
  Nonprescription Medication to Students (2005).
• Oregon Revised Statutes, Chapter 339.869
  Administration of medication to students rules
  (2001).
• Perry, A. G. Potter, P. A. (2006). Clinical
  nursing skills techniques (6th ed.).
  Philadelphia Mosby.
• Next

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• You have now completed the review. Click next to
  submit the results and complete a survey. The
  survey must be completed to document your
  training.

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