MEDICATIONS IN SCHOOLS: SECTION VI

1. MEDICATIONS IN SCHOOLS: SECTION VI Janie Lee Hall, School Health Advocate Office of School & Adolescent Health NMDOH, Public Health Regions 1&3 Presented by: Lee Carn, RN,BSN, RRPS

2. Definition: A medication is any substance that is ingested, injected, inhaled, or used topically in the diagnosis, treatment and/or the prevention of disease. • This includes prescription drugs, over-the-counter and non-prescription drugs, and non FDA-approved herbal/homeopathic remedies.

3. Options for Medication Administration in School • PED licensed professional school nurse (RN) • Delegation to appropriate staff (LPN/CMA/UAP/HA) • Student Self-Administration (strict criteria)

4. Self-Administration: Students may be allowed to assume responsibility for carrying and administering their own 1-day supply of medications (excluding controlled substances) provided that: • Self-administration is approved in writing by the prescribing health care provider, and the parent/guardian; • Nurse evaluates the student’s ability to safely & accurately self-administer.

5. Guidelines for Medications in Schools • Whenever possible, medication should be given at home. • Parents must provide the school with written medication orders each school year and each time the order changes • Orders must be signed by the PCP andthe parent/guardian. • The licensed professional school nurse must transcribe the orders onto the appropriate school forms prior to the medication being given. • Parent/guardian is responsible for providing the school with a pharmacy-labeled container and all medication • Un-used medication should be disposed of or returned according to written school board policy.

6. Medication Containers The Label must have the following: • Name of the student • Name of the medication • Drug strength and prescribed dosage • Route of administration • Time scheduled for administration • Name of prescribing health care provider (PCP)

7. The 6 Rights: • Right student • Right medication • Right dosage • Right time • Right route • Right documentation • And, the right reason, • That makes 7

8. Safety, Safety, Safety!! The Six R’s should be triple checked each and every time medication is administered. • First, when taking medication out of storage area. • Second, when assisting student with his/her medication. • Third, when returning medication to the storage area and documenting.

9. Teach the students to answer these 5 questions: Name (student’s) • What is your name? Medication • What is the name of your medication or is this your medication? Dose • How much do you take? Ordered time to take • When do you take this? Purpose of medication • Why do you take this?

10. Administering Medication to a Student: • Wash hands between each student • Identify each individual student • Unlock medication cabinet • Take the medication container out of the cabinet • Compare the label name and the student name with the MAR before administering the medication • Administer medication with out touching • Document (6th right)

11. Precautions: • Only a licensed professional school nurse can transcribe the original order onto the MAR • Only a nurse can take verbal orders or changes in the medication order from the provider. • Medication errors or omissions must be reported to the nurse and documented.

12. MEDICATION ERROR & INCIDENCE REPORT Errors may include the following: • Wrong student • Wrong medication and/or dose • Wrong route • Wrong time • Missed dose

13. Over-the Counter Medications: • OTCs are often requested by the parent; • Decision to administer requires school nurse’s judgment -- so only a nurse (or the parent) can make the decision to give OTCs; • Each district should have a policy for OTC meds. • Comfort measures should always be utilized first.

14. Same Day Field Trips • Optimally, a separate “single dose” field trip supply of medications (in an originally-labeled pharmacy container) should be made available by the PCP and parent/guardian • Alternately, the originally-labeled school supply should be checked out to the adult who is trained and delegated by the school nurse to administer the medication

15. State Laws: • Each local education agency must adopt a written policy that meets its students’ needs for prescription and non-prescription drugs. • All schools are required to authorize students to carry and self-administer asthma treatment medications, anaphylaxis emergency treatment medications, and diabetes treatment medications (under specific conditions).

16. Emergency Medications: Albuterol, Epinephrine, Glucagon & Oxygen • The School Nurse is responsible for training adult employees to administer these emergency medications when they are ordered at school.

17. Medication Storage: Routine medications should be stored in a locked cabinet in a secure area; FDA guidelines and national standards require that all controlled substances be stored in a double locked narcotic cabinet that is equipped with two separate locks and keys.

18. Refrigerated Meds: • Antibiotic elixirs usually require refrigeration. • The refrigerator should be in a secure area and not be accessible to unauthorized individuals. • Food should not be kept in the same refrigerator as medications. • The temperature should be checked daily when school is in session and should be maintained between 36 and 46 degrees Fahrenheit.

19. TRANSPORTING MEDICATION: Each school district should develop a written School Board policy addressing the issue of transporting medications. Topics to cover in this policy might include the following. • Medications transported to school • Medications transported from school • Medication transportation for emergency evacuation during the school day

20. Disposing of Medications Parents should be notified that it is their responsibility to pick up any unused medications • Never give students unused medications; even if parent instructs you to do so PED licensed RN should dispose of unused medications with adult witness

21. To Ensure Maximum protection: • Use approved prescription and over the counter authorization forms for parents and providers with signatures yearly and as needed. • The PED licensed school nurse must review, transcribe and sign all medication authorization forms. • Parent/guardian is responsible for providing the school with the medication in a pharmacy labeled container or the original manufacturer’s container.

22. Remember: • Always exercise great care with medications to ensure the safest possible care for students. • Keep students and yourself safe by meticulously following state guidelines and school district medication policy. • When in doubt, ALWAYS ask the school nurse!

23. NOTE: Poison Control (800-222-1222) is a valuable resource when you have questions about a medication.

24. QUESTIONS?