Improving Safety and Quality in Medication Management in Schools

1. Improving Safety and Quality in Medication Management in Schools Julia Graham Lear, PhD, Director, Center for Health & Health Care in Schools, GWU School of Public Health and Health Services, APHA, November 11, 2002. The Center for Health and Health Care in Schools

2. Being trained to give medication is not the critical issue -- The critical issue is having time to give it right and give the students the care they deserve. Secretaries have a full-time job and the care we give students is haphazard, not because we are not responsible or do not want to give good care -- it’s because we are already over-extended. The long and short of it, we are an accident waiting to happen!Elementary school secretarySeattle Public SchoolsMarch 29, 2001 The Center for Health and Health Care in Schools

3. Schools, Medicine, and Children: Basic Facts In school year 2000 - 2001, 53 million American children between ages 5 and 19 attended elementary or secondary school in U.S. A significant number have health problems that require medication or other medical treatment during the school day. Federal, state and local laws mandate that schools make required care available. Assuring safe management of medications given during the school day will require system changes. The Center for Health and Health Care in Schools

4. Common Health Problems of School-Age Children, 5 - 17, 1997 The Center for Health and Health Care in Schools

5. Policies & Practices Related to Medication Administration 64% of states and 94% of school districts have requirements regarding school administration of medications. BUT 74% of schools have a medical supply cabinet with a lock 65% have a separate medicine cabinet with a lock, and 57% have a refrigerator reserved for health services. The Center for Health and Health Care in Schools

6. School Nurse Report on Medication Administration PracticesMcCarthy et al. 5.6% of students required meds at school Prescription medications provided more frequently to children in E.S. and M.S. than pre-school and H.S. 98% report having medication guidelines; 91% have state guidelines for med administration. Almost all document each administration of medications (99%) but relatively few document side effects (20.7%) 48.5% of responding nurses reported a medication error in past year. The Center for Health and Health Care in Schools

7. Staffing for Medication Management in Schools Current staff who provide meds in schools: School nurses, UAPs inc. school secretaries School nurses: 30,000 - 40,000 for 115,000 elementary & secondary schools UAPs (unlicensed assistive personnel) includes health aides as well as school secretaries who have health-related functions. Unknown number. The Center for Health and Health Care in Schools

8. THE GOAL To reduce errors and improve performance in the administration of medications at school for 53 million American children between ages 5 and 19 who attend an elementary or secondary school in the United States. The Center for Health and Health Care in Schools

9. State and District Required Mandates The Center for Health and Health Care in Schools

10. Legal Requirements - Federal Section 504 of the Rehabilitation Act of 1973 - Sec. 504 declares that discrimination on the basis of disability is prohibited in federally funded programs. Individuals with Disabilities Education Act, as amended - For students whose disabilities may interfere with learning, school systems must make accommodations. Americans with Disabilities Act (ADA) extends protections of 504 to private schools. The Center for Health and Health Care in Schools

11. Legal Requirements - States Different approaches Generally admonitory rather than regulatory language, eg. “an effective medication policy will assure etc” Best practice recommendations, eg. AL guidelines for LEAs on medication administration recommended rather than required language, eg. MN state law says “Drugs and medicine..must be administered, to the extent possible, according to school board procedures” The Center for Health and Health Care in Schools

12. Legal Requirements - States An exception Washington State Code, RCW.28a.210.270 states: Simply because a school administers an OTC medication rather than a prescription medication does not relieve the school from an obligation to get a written, current and unexpired request.” Failure to do so may exclude the school from protection of the code which states that schools and their employees “shall not be liable in any criminal action or for civil damages.” The Center for Health and Health Care in Schools

13. Legal Requirements - Local • No comprehensive summary of local policies or regulations available • In general, follow nursing standards, recommendations of state boards of nursing, NASN and other professional organizations • To the extent there are requirements, they appear to involve liability issues. The Center for Health and Health Care in Schools

14. Improving Medication Management Safety & Quality: Basic Principles Designing systems to prevent error by reducing reliance of memory and vigilance. To design for safety means to think about work hours, work loads, appropriate training and to have systems that include procedures that make errors visible and that in the case of error, mitigate harm. The Center for Health and Health Care in Schools

15. Improving Medication Management Safety & Quality: Applying Lessons from Crossing the Quality Chasm System design using 80/20 principle: design for the usual, plan for the unusual. Develop simple low-cost process for performing routine work. Examples: Using photos attached to medications to assure accurate student identification Using electronic entry of medication admin information to track documentation & problems Designing system to improve safety requires a learning environment, not a blame & reprisal culture. The Center for Health and Health Care in Schools

16. Barriers to Safe, High Quality Medication Management Until their child gets sick, most parents do not know their school’s medication practices. Many school board members do not know their system’s medication management practices. Health services generally receive limited attention from school system policymakers. The people who know policies & practices -- school nurses & other school staff -- have limited input into the school system’s policy & budget process. The Center for Health and Health Care in Schools

17. New Forces for Change in School-Based Medication Management The safety & quality improvement movement. Role of Institute of Medicine reports: To Err is Human and Crossing the Quality Chasm Increasing numbers of best practices: a. Massachusetts Medication Management initiative in the 1990s b. Austin, TX/Seton Health System public reporting of school health performance The Center for Health and Health Care in Schools

18. References and Resources The Center for Health and Health Care in Schools

19. Contact Information The Center for Health and Health Care in Schools 1350 Connecticut Avenue, NW Suite 505 Washington, DC 20036 202-466-3396 202-466-3467 fax www.healthinschools.org The Center for Health and Health Care in Schools